Individual Proton Pump Inhibitors and Outcomes in Patients With Coronary Artery Disease on Dual Antiplatelet Therapy: A Systematic Review.
Abstract
BACKGROUND: Observational studies evaluating the possible interaction between proton
pump inhibitors (PPIs) and clopidogrel have shown mixed results. We conducted a systematic
review comparing the safety of individual PPIs in patients with coronary artery disease
taking clopidogrel. METHODS AND RESULTS: Studies performed from January 1995 to December
2013 were screened for inclusion. Data were extracted, and study quality was graded
for 34 potential studies. For those studies in which follow-up period, outcomes, and
multivariable adjustment were comparable, meta-analysis was performed.The adjusted
odds or hazard ratios for the composite of cardiovascular or all-cause death, myocardial
infarction, and stroke at 1 year were reported in 6 observational studies with data
on individual PPIs. Random-effects meta-analyses of the 6 studies revealed an increased
risk for adverse cardiovascular events for those taking pantoprazole (hazard ratio
1.38; 95% CI 1.12-1.70), lansoprazole (hazard ratio 1.29; 95% CI 1.09-1.52), or esomeprazole
(hazard ratio 1.27; 95% CI 1.02-1.58) compared with patients on no PPI. This association
was not significant for omeprazole (hazard ratio 1.16; 95% CI 0.93-1.44). Sensitivity
analyses for the coronary artery disease population (acute coronary syndrome versus
mixed) and exclusion of a single study due to heterogeneity of reported results did
not have significant influence on the effect estimates for any PPIs. CONCLUSIONS:
Several frequently used PPIs previously thought to be safe for concomitant use with
clopidogrel were associated with greater risk of adverse cardiovascular events. Although
the data are observational, they highlight the need for randomized controlled trials
to evaluate the safety of concomitant PPI and clopidogrel use in patients with coronary
artery disease.
Type
Journal articleSubject
adverse cardiovascular outcomesclopidogrel
coronary artery disease
medication interaction
proton pump inhibitor
Coronary Artery Disease
Drug Interactions
Drug Therapy, Combination
Humans
Observational Studies as Topic
Odds Ratio
Patient Safety
Platelet Aggregation Inhibitors
Proton Pump Inhibitors
Risk Assessment
Risk Factors
Ticlopidine
Treatment Outcome
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https://hdl.handle.net/10161/12646Published Version (Please cite this version)
10.1161/JAHA.115.002245Publication Info
Sherwood, Matthew W; Melloni, Chiara; Jones, W Schuyler; Washam, Jeffrey B; Hasselblad,
Vic; & Dolor, Rowena J (2015). Individual Proton Pump Inhibitors and Outcomes in Patients With Coronary Artery Disease
on Dual Antiplatelet Therapy: A Systematic Review. J Am Heart Assoc, 4(11). 10.1161/JAHA.115.002245. Retrieved from https://hdl.handle.net/10161/12646.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Rowena Joy Dolor
Professor of Medicine
Rowena J. Dolor, MD, MHS did her medical training and internal medicine residency
at Duke University Medical Center. She completed the Ambulatory Care/Health Services
Research fellowship at the Durham VA Medical Center in 1996 and obtained her Masters
in Health Sciences degree in Biometry (renamed MHS in Clinical Research) from the
Duke University School of Medicine in 1998. Dr. Dolor was a staff physician in the
Ambulatory Care Service at the Durham VA Medical Center and Research Associate at
t
Victor Hasselblad
Professor Emeritus of Biostatistics & Bioinformatics
The research interests of Vic Hasselblad include distribution fitting, sample size
and power calculations, dose-response estimation, meta-analysis, and non-inferiority
designs.
William Schuyler Jones
Associate Professor of Medicine
I am an interventional cardiologist with a specific focus on the diagnosis and treatment
of patients with cardiovascular disease. As a clinician, I see patients in the office
and do coronary and peripheral vascular procedures (angiography and interventions)
in the Duke Cardiac Catheterization Laboratory. I have served as the Medical Director
of the cath lab at Duke since 2016. Alongside my partners in the cath lab, we collaborate
with our cardiothoracic surgeons to hold Heart Team meetings each
Chiara Melloni
Adjunct Associate Professor in the Department of Medicine
Matthew William Sherwood
Adjunct Assistant Professor in the Department of Medicine
I am striving to become a clinical and research leader in structural heart disease
and complex coronary disease, specifically in the use of antithrombotic agents after
structural heart interventions. I will also explore the significance of bleeding/vascular
complications and stroke in these patients as well as potential therapies such as
transfusion, and embolic protection devices.
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