| Association of proton pump inhibitor use on cardiovascular outcomes with clopidogrel and ticagrelor: insights from the platelet inhibition and patient outcomes trial. | |
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MedLine Citation:
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PMID: 22261200 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The clinical significance of the interaction between clopidogrel and proton pump inhibitors (PPIs) remains unclear. METHODS AND RESULTS: We examined the relationship between PPI use and 1-year cardiovascular events (cardiovascular death, myocardial infarction, or stroke) in patients with acute coronary syndrome randomized to clopidogrel or ticagrelor in a prespecified, nonrandomized subgroup analysis of the Platelet Inhibition and Patient Outcomes (PLATO) trial. The primary end point rates were higher for individuals on a PPI (n=6539) compared with those not on a PPI (n=12 060) at randomization in both the clopidogrel (13.0% versus 10.9%; adjusted hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.04-1.38) and ticagrelor (11.0% versus 9.2%; HR, 1.24; 95% CI, 1.07-1.45) groups. Patients on non-PPI gastrointestinal drugs had similar primary end point rates compared with those on a PPI (PPI versus non-PPI gastrointestinal treatment: clopidogrel, HR, 0.98; 95% CI, 0.79-1.23; ticagrelor, HR, 0.89; 95% CI, 0.73-1.10). In contrast, patients on no gastric therapy had a significantly lower primary end point rate (PPI versus no gastrointestinal treatment: clopidogrel, HR, 1.29; 95% CI, 1.12-1.49; ticagrelor, HR, 1.30; 95% CI, 1.14-1.49). CONCLUSIONS: The use of a PPI was independently associated with a higher rate of cardiovascular events in patients with acute coronary syndrome receiving clopidogrel. However, a similar association was observed between cardiovascular events and PPI use during ticagrelor treatment and with other non-PPI gastrointestinal treatment. Therefore, in the PLATO trial, the association between PPI use and adverse events may be due to confounding, with PPI use more of a marker for, than a cause of, higher rates of cardiovascular events. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT00391872. |
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Authors:
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Shaun G Goodman; Robert Clare; Karen S Pieper; José C Nicolau; Robert F Storey; Warren J Cantor; Kenneth W Mahaffey; Dominick J Angiolillo; Steen Husted; Christopher P Cannon; Stefan K James; Jan Kilhamn; P Gabriel Steg; Robert A Harrington; Lars Wallentin; |
Publication Detail:
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Type: Clinical Trial, Phase III; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2012-01-18 |
Journal Detail:
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Title: Circulation Volume: 125 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2012 Feb |
Date Detail:
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Created Date: 2012-02-28 Completed Date: 2012-04-19 Revised Date: 2012-11-05 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 978-86 Citation Subset: AIM; IM |
Affiliation:
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MSc, Division of Cardiology, St. Michael's Hospital, 30 Bond St, Room 6-034, Queen, Toronto, Ontario, Canada M5B 1W8. goodmans@chrc.net |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00391872 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adenosine
/
adverse effects,
analogs & derivatives*,
blood,
therapeutic use Aged Double-Blind Method Female Humans Male Middle Aged Myocardial Infarction / blood, chemically induced, epidemiology* Platelet Aggregation Inhibitors / adverse effects, blood, therapeutic use* Proton Pump Inhibitors / adverse effects, blood, therapeutic use* Stroke / blood, chemically induced, epidemiology* Ticlopidine / adverse effects, analogs & derivatives*, blood, therapeutic use Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Platelet Aggregation Inhibitors; 0/Proton Pump Inhibitors; 0/Ticagrelor; 55142-85-3/Ticlopidine; 58-61-7/Adenosine; 90055-48-4/clopidogrel |
| Comments/Corrections | |
Comment In:
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Circulation. 2012 Sep 11;126(11):e170; author reply e171-2
[PMID:
22965784
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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