Concomitant Use of Clopidogrel, Proton Pump Inhibitors May Reduce Hospitalizations for Gastroduodenal Bleeding
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The latest study to examine concurrent administration of clopidogrel and proton pump inhibitors (PPIs) found 50% fewer hospitalizations for gastroduodenal bleeding among patients who received both drugs, compared with patients who received clopidogrel alone.
Of note, concurrent PPI use was not associated with a significantly increased risk for serious cardiovascular disease.
The retrospective cohort study used data from the Tennessee Medicaid program to identify patients who had been treated with clopidogrel after hospitalization for coronary heart disease (acute myocardial infarction, coronary artery revascularization, or unstable angina) between 1999 and 2005. Of 20,596 patients included in the analysis, 7,593 had concurrent PPI use. Pantoprazole was used most commonly (62% of patients); only 9% of the cohort used omeprazole.
The incidence of hospitalizations for gastroduodenal bleeding among patients treated with clopidogrel alone was 12.2 per 1,000 person-years of follow-up, compared with 8.2 in concurrent users of clopidogrel and PPIs. For patients with three or more recognized risk factors for gastroduodenal bleeding, current PPI use was associated with an absolute reduction in hospitalizations of 28.5 per 1,000 person-years. The corresponding point estimate for serious cardiovascular disease—defined as fatal or nonfatal myocardial infarction or sudden cardiac death, stroke, or other cardiovascular death—was not increased.
The authors concluded that the risks of PPI use (adverse cardiovascular events) could exceed the benefits (prevented bleeding) in patients with low or moderate risk for gastrointestinal bleeding and higher risk for cardiovascular diseases.
Ann Intern Med. 2010;152:337-45.