Affordable Access

Publisher Website

Effect of Concomitant Use of Clopidogrel and Proton Pump Inhibitors After Percutaneous Coronary Intervention

The American Journal of Cardiology
Publication Date
DOI: 10.1016/j.amjcard.2010.10.073
  • Medicine


The aim of the present study was to analyze the effect of drug exposure patterns of clopidogrel and proton pump inhibitors (PPIs) on the clinical outcomes after percutaneous coronary intervention (PCI). Previous analyses predominantly included discharge medications and did not explore the effect of the drug exposure patterns. We analyzed all-cause death, nonfatal myocardial infarction, repeat revascularization, and major adverse cardiovascular events (MACE) in a cohort of 23,200 post-PCI patients (January 2003 to December 2008) using a multivariate adjusted Cox model and propensity-matched case-control analysis. The adjusted hazard ratio for MACE on PPI according to the exposure patterns of clopidogrel after PCI for 6 years was 1.24 (95% confidence interval [CI] 1.11 to 1.38) and 1.12 (95% CI 1.03 to 1.22) for “continuous” (consistent clopidogrel with or without PPIs) and “switched” (clopidogrel with or without varying PPIs) respectively. However, the propensity score adjusted odds ratios for MACE on PPI use was 0.97 (95% CI 0.65 to 1.44) for “continuous” and 1.04 (95% CI 0.87 to 1.25) for “switched.” Moreover, in the first year after PCI, the use of “rescue” (≤30 days before MACE) nitroglycerin was greater in the patients taking clopidogrel and PPIs than in those taking clopidogrel alone, as was the overall use of rescue PPIs (p <0.001). In conclusion, PPI use in clopidogrel-treated post-PCI patients was not associated with an increased risk of MACE after controlling for the confounding effect of PPI use with propensity matching. A potential for the misdiagnosis of angina symptoms and rescue use of nitroglycerin and PPIs in post-PCI patients exists, a finding that might have confounded previous observational analyses.

There are no comments yet on this publication. Be the first to share your thoughts.


Seen <100 times

More articles like this

Clinical outcomes in patients with the concomitant...

on Circulation. Cardiovascular in... Apr 01, 2011

Risk of Adverse Outcomes in Taiwan Associated With...

on The American Journal of Cardio... Jan 01, 2010

Risk of adverse clinical outcomes with concomitant...

on Digestive Diseases and Science... July 2010

Safety of concomitant use of proton pump inhibitor...

on The American Journal of Medici... April 2010
More articles like this..