Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Dec 20;130(24):2899-2905.
doi: 10.4103/0366-6999.220304.

Impact of Proton-pump Inhibitors on the Pharmacodynamic Effect and Clinical Outcomes in Patients Receiving Dual Antiplatelet Therapy after Percutaneous Coronary Intervention: A Propensity Score Analysis

Pei Zhu  1 , Zhan Gao  1 , Xiao-Fang Tang  1 , Jing-Jing Xu  1 , Yin Zhang  1 , Li-Jian Gao  1 , Jue Chen  1 , Shu-Bin Qiao  1 , Yue-Jin Yang  1 , Run-Lin Gao  1 , Bo Xu  1 , Jin-Qing Yuan  1
Affiliations

Impact of Proton-pump Inhibitors on the Pharmacodynamic Effect and Clinical Outcomes in Patients Receiving Dual Antiplatelet Therapy after Percutaneous Coronary Intervention: A Propensity Score Analysis

Pei Zhu et al. Chin Med J (Engl). .

Abstract

Background: Prior studies have reported controversial conclusions regarding the risk of adverse cardiovascular events in patients using proton-pump inhibitors (PPIs) combined with clopidogrel therapy, causing much uncertainty in clinical practice. We sought to evaluate the safety of PPIs use among high-risk cardiovascular patients who underwent percutaneous coronary intervention (PCI) in a long-term follow-up study.

Methods: A total of 7868 consecutive patients who had undergone PCI and received dual antiplatelet therapy (DAPT) at a single center from January 2013 to December 2013 were enrolled. Adenosine diphosphate (ADP)-induced platelet aggregation inhibition was measured by modified thromboelastography (mTEG) in 5042 patients. Propensity score matching (PSM) was applied to control differing baseline factors. Cox proportional hazards regression was used to evaluate the 2-year major adverse cardiovascular and cerebrovascular events (MACCEs), as well as individual events, including all-cause death, myocardial infarction, unplanned target vessel revascularization, stent thrombosis, and stroke.

Results: Among the whole cohort, 27.2% were prescribed PPIs. The ADP-induced platelet aggregation inhibition by mTEG was significantly lower in PPI users than that in non-PPI users (42.0 ± 30.9% vs. 46.4 ± 31.4%, t = 4.435, P < 0.001). Concomitant PPI use was not associated with increased MACCE through 2-year follow-up (12.7% vs. 12.5%, χ2 = 0.086, P = 0.769). Other endpoints showed no significant differences after multivariate adjustment, regardless of PSM.

Conclusion: In this large cohort of real-world patients, the combination of PPIs with DAPT was not associated with increased risk of MACCE in patients who underwent PCI at up to 2 years of follow-up.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Patient flowchart for the study cohort. PCI: Percutaneous coronary intervention; DAPT: Dual antiplatelet therapy; OAC: Oral anticoagulants; PPI: Proton-pump inhibitors; mTEG: Modified thromboelastograph.
See this image and copyright information in PMC

References

    1. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The task force for dual antiplatelet therapy in coronary artery disease of the European society of cardiology (ESC) and of the European association for cardio-thoracic surgery (EACTS) Eur Heart J. [Epub ahead of print] doi: 10.1093/eurheartj/ehx419. - PubMed
    1. Chandrasekhar J, Bansilal S, Baber U, Sartori S, Aquino M, Farhan S, et al. Impact of proton pump inhibitors and dual antiplatelet therapy cessation on outcomes following percutaneous coronary intervention: Results from the PARIS registry. Catheter Cardiovasc Interv. 2017;89:E217–25. doi: 10.1002/ccd.26716. - PubMed
    1. Juurlink DN, Gomes T, Paterson JM, Hellings C, Mamdani MM. Trends in the coprescription of proton pump inhibitors with clopidogrel: An ecological analysis. CMAJ Open. 2015;3:E428–31. doi: 10.9778/cmajo.20140078. - PMC - PubMed
    1. Gilard M, Arnaud B, Cornily JC, Le Gal G, Lacut K, Le Calvez G, et al. Influence of omeprazole on the antiplatelet action of clopidogrel associated with aspirin: The randomized, double-blind OCLA (Omeprazole CLopidogrel aspirin) study. J Am Coll Cardiol. 2008;51:256–60. doi: 10.1016/j.jacc.2007.06.064. - PubMed
    1. Juurlink DN, Gomes T, Ko DT, Szmitko PE, Austin PC, Tu JV, et al. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ. 2009;180:713–8. doi: 10.1503/cmaj.082001. - PMC - PubMed