The Impact of Concomitant Use of Proton Pump Inhibitors and Clopidogrel on Patient Mortality and Outcome Post Angioplasty
Shaban Mohammed1, Abdulrahaman Arabi1, Nawel Bensmail1, Ahmed Moursi1, Mohamed Sharabash1, Ayman El-Menyar1, Rania Abdel-Latif2, Salah Arafa1, Ihsan Rafie1, Awad Alqahtani1, Moza Al Hail1, Nidal Asaad1, Jassim Al Suwaidi3
Heart Hospital Hamad Medical Corporation, Qatar1, Minia University, Egypt2, Heart hospital Hamad Medical Corporation, Qatar3
Numerous studies have suggested the routinely prescribed proton-pump inhibitors (PPIs) for patients receiving dual antiplatelet therapy post angioplasty, would blunt platelet inhibitory effects of clopidogrel. However, evidence on the clinical consequences of concomitant use of PPI and clopidogrel post angioplasty showing a large diversity. This study was conducted to investigate the impact of PPI administration on clinical outcome and mortality in patients treated with clopidogrel after percutaneous coronary intervention (PCI).
During this retrospective cohort study, all patients who had PCI were identified during the period of October 2012 to March 2013. All involved participants were represented in the only tertiary heart hospital in Qatar for PCI. An eighteen-month follow-up period was assigned to report clinical outcome and tract clopidogrel and PPI use.
Of 550 patients who underwent PCI and taking clopidogrel, 375 (68%) were discharged on PPI. Current demographic data including age, sex/gender, race, and ethnicity showed a non-significant difference between patients who received PPI (PPI group) and those who were not received PPI (non-PPI group). Percentage of diabetic and hypertensive patients were comparable in both PPI and non-PPI groups (35.2, 39.2 vs. 33.7, 45.1%; p=0.73 and p=0.19, respectively). In analyses of clinical outcomes, regardless of the type of PPI, patients taking clopidogrel plus PPI showed a non-significant difference in the rate of restenosis (2.9 vs. 4.0%; p=0.51) and stent thrombosis (0.5 vs. 0.6%; p=0.95) compared to non-PPI patients’ group. Hospital re-admission rate for recurrent cardiovascular events was in significance in PPI group compared with non-PPI group (26.1 vs. 26.3%, p=0.97). PPI patients group showed a non-significant in-hospital mortality rate (1.9%) and one-year mortality rate (3.5%) compared with non-PPI patients’ group (1.7; p=0.9) and (1.7; p=0.25) respectively. In a multivariate analysis, the use of PPI was not associated with one-year mortality in patients treated with clopidogrel after PCI (odds ratio, 1.25; 95% confidence interval (CI)), 0.327-4.846; p=0.73). Additionally, the adjusted hazard ratio (HR) of PPI-use for mortality was 1.25 (95% confidence interval (CI): 0.69-3.3, p= 0.303).
Among patients on clopidogrel after PCI, the use of PPI was not associated with long-term mortality. Clinical outcomes were also not appreciably different according to PPI use. further randomized clinical trials are needed to evaluate the safety of concomitant PPI and clopidogrel use in patients with CAD.