Document Detail


Risk of rehospitalization for patients using clopidogrel with a proton pump inhibitor.
MedLine Citation:
PMID:  20421557     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Recent pharmacodynamic and retrospective clinical analyses have suggested that proton pump inhibitors (PPIs) may modify the antiplatelet effects of clopidogrel bisulfate. METHODS: We conducted a retrospective cohort study of persons enrolled in a multistate health insurance plan with commercial and Medicare clients to evaluate adverse clinical outcomes in patients using clopidogrel plus a PPI compared with clopidogrel alone. Patients who were discharged from the hospital after myocardial infarction (MI) or coronary stent placement and treated with clopidogrel plus a PPI (n = 1033) were matched 1:1 (using propensity scoring) with patients with similar cardiovascular risk factors treated with clopidogrel alone. Rehospitalizations for MI or coronary stent placement were evaluated for up to 360 days. A subanalysis was conducted to study the impact of pantoprazole sodium, the most used PPI. RESULTS: Patients who received clopidogrel plus a PPI had a 93% higher risk of rehospitalization for MI (adjusted hazard ratio, 1.93; 95% confidence interval, 1.05-3.54; P = .03) and a 64% higher risk of rehospitalization for MI or coronary stent placement (1.64; 1.16-2.32; P = .005) than did patients receiving clopidogrel alone. Increased risk of rehospitalization for MI or coronary stent placement was also observed for the subgroup of patients receiving clopidogrel plus pantoprazole (adjusted hazard ratio, 1.91; 95% confidence interval, 1.19-3.06; P = .008). CONCLUSIONS: Patients who received clopidogrel plus a PPI had a significantly higher risk of rehospitalization for MI or coronary stent placement than did patients receiving clopidogrel alone. Prospective clinical trials and laboratory analyses of biochemical interactions are warranted to further evaluate the potential impact of PPIs on the efficacy of clopidogrel.
Authors:
Karen M Stockl; Lisa Le; Armen Zakharyan; Ann S M Harada; Brian K Solow; Joseph E Addiego; Scott Ramsey
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Archives of internal medicine     Volume:  170     ISSN:  1538-3679     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-27     Completed Date:  2010-05-12     Revised Date:  2010-10-04    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  704-10     Citation Subset:  AIM; IM    
Affiliation:
PharmD, Outcomes Research, Department of Clinical Services, Prescription Solutions, 2300 Main St, Mail Stop CA 134-0404, Irvine, CA 92614, USA. karen.stockl@rxsol.com
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Aged, 80 and over
Case-Control Studies
Cohort Studies
Confidence Intervals
Coronary Restenosis / epidemiology*,  etiology
Drug Interactions
Drug Therapy, Combination
Female
Humans
Male
Middle Aged
Myocardial Infarction / diagnosis,  drug therapy*,  mortality
Patient Readmission / statistics & numerical data*
Probability
Proportional Hazards Models
Proton Pump Inhibitors / adverse effects,  therapeutic use*
Reference Values
Retrospective Studies
Risk Assessment
Sex Factors
Survival Rate
Ticlopidine / adverse effects,  analogs & derivatives*,  therapeutic use
Chemical
Reg. No./Substance:
0/Proton Pump Inhibitors; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel
Comments/Corrections
Comment In:
Arch Intern Med. 2010 Sep 13;170(16):1507-8; author reply 1508   [PMID:  20837843 ]
Arch Intern Med. 2010 Sep 27;170(17):1604-5   [PMID:  20876414 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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