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Concomitant use of proton-pump inhibitors and clopidogrel in patients with coronary, cerebrovascular or peripheral artery disease in the FRENA Registry.
MedLine Citation:
PMID:  21164357     Owner:  NLM     Status:  Publisher    
Background Among patients receiving clopidogrel for coronary artery disease (CAD), concomitant therapy with proton-pump inhibitors (PPIs) has been associated with an increased risk for recurrent coronary events. Patients and Methods FRENA is an ongoing, multicenter, observational registry of consecutive outpatients with CAD, cerebrovascular (CVD) or peripheral artery (PAD) disease. We retrospectively examined the influence of concomitant use of PPIs on outcome in patients receiving clopidogrel. Results As of March 2009, 1222 patients were using clopidogrel: 595 had CAD, 329 CVD, 298 had PAD. Of these, 519 (42%) were concomitantly using PPIs. Over a mean follow-up of 15 months, 131 patients (11%) had 139 subsequent ischemic events: myocardial infarction 44, ischemic stroke 40, critical limb ischemia 55. Seventeen of them (13%) died within 15 days of the subsequent event. PPI users had a higher incidence of myocardial infarction (rate ratio: 2.5; 95% CI: 1.3-4.8), ischemic stroke (rate ratio: 1.9; 95% CI: 1.03-3.7), and a non-significantly higher rate of critical limb ischemia (rate ratio: 1.6; 95% CI: 0.95-2.8) than non-users. On multivariate analysis, concomitant use of clopidogrel and PPIs was independently associated with an increased risk for subsequent ischemic events both in the whole series of patients (hazard ratio: 1.8; 95% CI: 1.1-2.7), and in those with CVD or PAD (hazard ratio: 1.5; 95% CI: 1.01-2.4). Conclusions In patients with established arterial disease, concomitant use of PPIs and clopidogrel was associated with a nearly doubling of the incidence of subsequent myocardial infarction or ischemic stroke. This higher incidence persisted after multivariate adjustment.
Juan Francisco Sánchez Muñoz-Torrero; Domingo Escudero; Carmen Suárez; Carmen Sanclemente; M Teresa Pascual; José Zamorano; Javier Trujillo-Santos; Manuel Monreal;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-12-15
Journal Detail:
Title:  Journal of cardiovascular pharmacology     Volume:  -     ISSN:  1533-4023     ISO Abbreviation:  -     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7902492     Medline TA:  J Cardiovasc Pharmacol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Department of Internal Medicine. Hospital San Pedro de Alcántara. Cáceres; 2Department of Neurology. Hospital Universitari Germans Trias i Pujol. Badalona, Barcelona; 3Department of Internal Medicine. Hospital Universitario de La Princesa. Madrid; 4Department of Internal Medicine. Hospital Universitari de Bellvitge, Barcelona; 5Department of Internal Medicine. Hospital Universitari Germans Trias i Pujol. Badalona, Barcelona; 6Research Unit. Hospital San Pedro de Alcántara. Cáceres; 7Department of Internal Medicine. Hospital Santa Maria del Rosell. Cartagena; and 8Department of Internal Medicine. Hospital Universitari Germans Trias i Pujol. Badalona, Barcelona.
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