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Individual Proton Pump Inhibitors and Outcomes in Patients With Coronary Artery Disease on Dual Antiplatelet Therapy: A Systematic Review.

dc.contributor.author Dolor, RJ
dc.contributor.author Hasselblad, V
dc.contributor.author Jones, WS
dc.contributor.author Melloni, Chiara
dc.contributor.author Sherwood, MW
dc.contributor.author Washam, JB
dc.coverage.spatial England
dc.date.accessioned 2016-08-14T16:11:09Z
dc.date.issued 2015-10-29
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/26514161
dc.identifier JAHA.115.002245
dc.identifier.uri http://hdl.handle.net/10161/12646
dc.description.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.
dc.language eng
dc.relation.ispartof J Am Heart Assoc
dc.relation.isversionof 10.1161/JAHA.115.002245
dc.subject adverse cardiovascular outcomes
dc.subject clopidogrel
dc.subject coronary artery disease
dc.subject medication interaction
dc.subject proton pump inhibitor
dc.subject Coronary Artery Disease
dc.subject Drug Interactions
dc.subject Drug Therapy, Combination
dc.subject Humans
dc.subject Observational Studies as Topic
dc.subject Odds Ratio
dc.subject Patient Safety
dc.subject Platelet Aggregation Inhibitors
dc.subject Proton Pump Inhibitors
dc.subject Risk Assessment
dc.subject Risk Factors
dc.subject Ticlopidine
dc.subject Treatment Outcome
dc.title Individual Proton Pump Inhibitors and Outcomes in Patients With Coronary Artery Disease on Dual Antiplatelet Therapy: A Systematic Review.
dc.type Journal article
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/26514161
pubs.issue 11
pubs.organisational-group Basic Science Departments
pubs.organisational-group Biostatistics & Bioinformatics
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Cardiology
pubs.organisational-group Medicine, Clinical Pharmacology
pubs.organisational-group Medicine, General Internal Medicine
pubs.organisational-group School of Medicine
pubs.publication-status Published online
pubs.volume 4
dc.identifier.eissn 2047-9980


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