Prognosis of concomitant users of clopidogrel and proton-pump inhibitors in a high-risk population for upper gastrointestinal bleeding.

Qing Wang,Yunxia Lu,Jesper Lagergren,Rickard Ljung

doi:10.1186/2050-6511-15-22

Abstract

BackgroundIt is unclear whether concomitant use of clopidogrel and proton-pump inhibitors (PPIs) increases the risk of recurrence of cardiovascular disease or death in patients at high risk of upper gastrointestinal (GI) bleeding.MethodsBased on the Swedish Patient Register, a cohort of cardiovascular disease (including acute myocardial infarction, stroke and angina, from 2006 to 2008) was selected from a population with any diagnosis of upper GI bleeding. Data on drug prescription was retrieved from the Prescribed Drug Register. Patients entered into the cohort after their first discharge for cardiovascular disease and were followed up to death, recurrence of cardiovascular disease, or 90 days. A Cox regression model was conducted and hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated to evaluate the risks among users of different drug prescriptions.ResultsPatients who were current users of only PPIs (HR 2.02, 95% CI 1.19-3.44), only clopidogrel (HR 1.14, 95% CI 0.53-2.45) and nonusers of both (HR 2.36, 95% CI 1.39-4.00) were at a higher risk of death compared with patients with a concomitant use. Results were similar among 1779 patients who had any history of upper GI bleeding (HR 2.05, 95% CI 1.18-3.54; HR 1.25, 95% CI 0.57-2.72; HR 2.30, 95% CI 1.33-3.98, respectively).ConclusionAmong patients at high risk of upper GI bleeding, those with a concomitant use of PPIs and clopidogrel were at a decreased risk of mortality, and possibly also a decreased risk of recurrence of cardiovascular disease.

Highlights

It is unclear whether concomitant use of clopidogrel and proton-pump inhibitors (PPIs) increases the risk of recurrence of cardiovascular disease or death in patients at high risk of upper gastrointestinal (GI) bleeding
We focused on cardiovascular disease with any diagnosis of upper GI bleeding to clarify whether concomitant use of clopidogrel and PPIs increases the risk of recurrence of cardiovascular disease or death, compared with other treatment strategies
Hazard ratios for different drug exposures in the cardiovascular disease cohort The hazard ratios (HRs) for risk of death within 90 days of follow-up was 2.02 for current users of only PPIs, 1.14 for current users of only clopidogrel, and 2.36 among patients with no PPI or clopidogrel prescription, compared with patients using PPIs and clopidogrel concomitantly (Table 2)

Summary

Introduction

It is unclear whether concomitant use of clopidogrel and proton-pump inhibitors (PPIs) increases the risk of recurrence of cardiovascular disease or death in patients at high risk of upper gastrointestinal (GI) bleeding. Few studies have focused on patients with cardiovascular disease at high risk of upper GI bleeding [23]. Most have excluded patients with a history of GI bleeding [14,17,18,20,24] these patients might be at high risk of a recurrence of severe GI bleeding These studies have mainly evaluated the combined use of clopidogrel and aspirin together with PPIs which might dilute or mix the real interaction between clopidogrel and PPIs [25,26]. The recurrence of cardiovascular disease is, generally difficult to be identified completely

Methods

Results

Conclusion