ISSN 1671-5411 CN 11-5329/R
Yan YAN, Xiao WANG, Jing-Yao FAN, Shao-Ping NIE, Sergio Raposeiras-Roubin, Emad Abu-Assi, Jose P Simao Henriques, Fabrizio D’Ascenzo, Jorge Saucedo, Jose R Gonzalez-Juanatey, Stephen B Wilton, Wouter J Kikkert, Ivan Nunez-Gil, Albert Ariza-Sole, Xian-Tao SONG, Dimitrios Alexopoulos, Christoph Liebetrau, Tetsuma Kawaji, Claudio Moretti, Zenon Huczek, Toshiharu Fujii, Luis C Correia, Masa-aki Kawashiri, Sasko Kedev, On behalf of the Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome (BleeMACS) Registry Investigators. Impact of concomitant use of proton pump inhibitors and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome. J Geriatr Cardiol 2016; 13(3): 209-217. doi: 10.11909/j.issn.1671-5411.2016.03.007
Citation: Yan YAN, Xiao WANG, Jing-Yao FAN, Shao-Ping NIE, Sergio Raposeiras-Roubin, Emad Abu-Assi, Jose P Simao Henriques, Fabrizio D’Ascenzo, Jorge Saucedo, Jose R Gonzalez-Juanatey, Stephen B Wilton, Wouter J Kikkert, Ivan Nunez-Gil, Albert Ariza-Sole, Xian-Tao SONG, Dimitrios Alexopoulos, Christoph Liebetrau, Tetsuma Kawaji, Claudio Moretti, Zenon Huczek, Toshiharu Fujii, Luis C Correia, Masa-aki Kawashiri, Sasko Kedev, On behalf of the Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome (BleeMACS) Registry Investigators. Impact of concomitant use of proton pump inhibitors and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome. J Geriatr Cardiol 2016; 13(3): 209-217. doi: 10.11909/j.issn.1671-5411.2016.03.007

Impact of concomitant use of proton pump inhibitors and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome

doi: 10.11909/j.issn.1671-5411.2016.03.007
  • Received Date: 2016-02-17
  • Rev Recd Date: 2016-02-17
  • Publish Date: 2016-03-27
  • Background There is great debate on the possible adverse interaction between proton pump inhibitors (PPIs) and clopidogrel. In addition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods We retrospectively analyzed data from a “real world”, international, multi-center registry between 2003 and 2014 (n = 15,401) and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint (all-cause death, re-infarction, or severe bleeding) in patients with ACS after PCI. Results Of 9,429 patients in the final cohort, 54.8% (n = 5165) was prescribed a PPI at discharge. Patients receiving a PPI were older, more often female, and were more likely to have comorbidities. No association was observed between PPI use and the primary endpoint for patients receiving clopidogrel (adjusted HR: 1.036; 95% CI: 0.903–1.189) or ticagrelor (adjusted HR: 2.320; 95% CI: 0.875–6.151) (Pinteraction = 0.2004). Similarly, use of a PPI was not associated with increased risk of all-cause death, re-infarction, or a decreased risk of severe bleeding for patients treated with either clopidogrel or ticagrelor. Conclusions In patients with ACS following PCI, concomitant use of PPIs was not associated with increased risk of adverse outcomes in patients receiving either clopidogrel or ticagrelor. Our findings indicate it is reasonable to use a PPI in combination with clopidogrel or ticagrelor, especially in patients with a higher risk of gastrointestinal bleeding.
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