Abstract
BackgroundSome clinical studies have demonstrated that the proton pump inhibitor (PPI) could decrease clopidogrel platelet response and increase major adverse cardiovascular events (MACE) in white or black subjects. However, that remains to be determined in Chinese patients. In this study, we sought to determine whether there could be an increased risk for developing MACE after concomitant use of dual antiplatelet therapy (DAT) and a PPI in Chinese patients treated with percutaneous coronary intervention (PCI) and stenting.MethodsThis study was a 5-year, single-center, retrospective cohort analysis of eligible patients (n = 6188) who received DAT and a PPI concomitantly (defined as PPI users) before discharge and/or 12-month follow-up after discharge as compared with those who received DAT alone (also defined as non-PPI users, n = 1465). The incidence of recurrent MACE, such as myocardial infarction (MI), definite stent thromboses (ST), or cardiovascular death, was compared between the PPI users and non-users.ResultsPPI users had a significantly higher incidence of the MACE than non-users (13.9% vs. 10.6%; adjusted HR: 1.33; 95% CI: 1.12 – 1.57, P = 0.007). Stratified analysis revealed that concurrent use of DAT and a PPI was associated with a significantly increased risk for developing ST compared with DAT alone (1% vs. 0.4%; adjusted HR: 2.66, 95% CI: 1.16 – 5.87, P = 0.012). However, there were no significant differences in the risk of MI, cardiovascular death and other adverse events, regardless of combination of clopidogrel and a PPI.ConclusionsThe study further suggests that concomitant use of DAT and a PPI may be associated with an increased risk for developing MACE, in particular definite ST, in Chinese PCI patients after discharge as compared with use of DAT alone.
Highlights
Clopidogrel, an oral antiplatelet agent, is extensively used to prevent adverse cardiovascular events in patients with acute coronary syndromes (ACS) or those undergoing percutaneous coronary intervention (PCI) for stenting [1]
Using the prescription records, including hospitalized medical records at discharge, outpatient clinical visits, questionnaires or telephone interview during the follow-up period, we systematically evaluated exposure of each patient to clopidogrel, aspirin, and/or a pump inhibitor (PPI) within 1 year after discharge
Data Collection of Clinical Research Study The records of hospitalized patients included detailed information on the dates of hospital admission and discharge, discharge diagnosis, specified treatment procedures, co-medication, and clinical efficacy before discharge and 12-month follow-up after discharge. We systematically evaluated their demographic characteristics and baseline data, including age, gender, body mass index (BMI), lifestyle habits, biochemical testing, potential risk factors and concurrent medications at discharge
Summary
Clopidogrel, an oral antiplatelet agent, is extensively used to prevent adverse cardiovascular events in patients with acute coronary syndromes (ACS) or those undergoing percutaneous coronary intervention (PCI) for stenting [1]. Clopidogrel active metabolite in plasma irreversibly binds to platelet ADP receptor P2Y12, and suppresses ADP-induced platelet aggregation. This conversion is catalyzed by several cytochrome P450 (CYP) enzymes, of which CYP2C19 is the most important [3]. Some clinical studies have demonstrated that the proton pump inhibitor (PPI) could decrease clopidogrel platelet response and increase major adverse cardiovascular events (MACE) in white or black subjects. We sought to determine whether there could be an increased risk for developing MACE after concomitant use of dual antiplatelet therapy (DAT) and a PPI in Chinese patients treated with percutaneous coronary intervention (PCI) and stenting
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