Lack of Significant Interactions Between Clopidogrel and Proton Pump Inhibitor Therapy: Meta-Analysis of Existing Literature

被引:36
作者
Gerson, Lauren B. [1 ,2 ]
McMahon, Donal [3 ]
Olkin, Ingram [3 ]
Stave, Christopher [2 ]
Rockson, Stanley G. [2 ,4 ]
机构
[1] Stanford Univ, Div Gastroenterol & Hepatol, Redwood City, CA 94063 USA
[2] Stanford Univ, Dept Med, Stanford, CA 94305 USA
[3] Stanford Univ, Dept Stat, Stanford, CA 94305 USA
[4] Stanford Univ, Dept Cardiol, Stanford, CA 94305 USA
关键词
Proton pump inhibitor; Clopidogrel; Meta-analysis; PERCUTANEOUS CORONARY INTERVENTION; ACUTE MYOCARDIAL-INFARCTION; CARDIOVASCULAR EVENTS; STENT PLACEMENT; CONCOMITANT USE; 1ST YEAR; IMPACT; RISK; OUTCOMES; MORTALITY;
D O I
10.1007/s10620-011-2007-1
中图分类号
R57 [消化系及腹部疾病];
学科分类号
100201 [内科学];
摘要
Published data regarding the effect of concomitant clopidogrel and proton pump inhibitor (PPI) therapy on cardiovascular outcomes have been conflicting. To perform an updated meta-analysis in order to determine changes in risk differences (RD) between primary and secondary outcome analyses. Primary analysis was based on definite vascular outcomes, including all cause mortality, cardiac death, myocardial infarction, and/or stroke. Secondary analysis also incorporated probable cardiac events, which included re-hospitalization for cardiac symptoms or revascularization procedures. RD were combined using a random-effects model. We reviewed 1,204 publications of which 26 studies (16 published articles, 10 abstracts) met inclusion criteria. The meta-analysis of outcomes from the two randomized controlled trials did not show an increased risk (RD 0.0, 95% CI -0.01, 0.01) for adverse outcomes. The meta-analysis of primary outcomes showed a RD of 0.02 (95% CI 0.01, 0.03) for all studies. The meta-analysis for secondary outcomes yielded a RD of 0.02 (95% CI 0.01-0.04) based on 19 published papers and abstracts. When primary and secondary outcomes were combined, the meta-analysis for published papers yielded an overall RD of 0.05 (95% CI 0.03-0.06). In patients using concomitant clopidogrel and PPI therapy, the risk of adverse cardiac outcomes was 0% based on data from well-controlled randomized trials. Data from retrospective studies and the addition of probable vascular events significantly increased the RD estimates, likely due to lack of adjustment for potential confounders.
引用
收藏
页码:1304 / 1313
页数:10
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