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
. 2024 Jul 24:11:1385318.
doi: 10.3389/fcvm.2024.1385318. eCollection 2024.

A network meta-analysis: evaluating the efficacy and safety of concurrent proton pump inhibitors and clopidogrel therapy in post-PCI patients

Ming-Ying Ai  1 , Yan-Zuo Chen  1 , Chien-Liang Kuo  1 , Wei-Lun Chang  1
Affiliations

A network meta-analysis: evaluating the efficacy and safety of concurrent proton pump inhibitors and clopidogrel therapy in post-PCI patients

Ming-Ying Ai et al. Front Cardiovasc Med. .

Abstract

Introduction: The objective of this research was to evaluate the risk of major adverse cardiovascular events (MACEs) associated with the use of various proton pump inhibitors (PPIs) in combination with clopidogrel in patients who underwent percutaneous coronary intervention (PCI).

Methods: To accomplish this, we analyzed data from randomized controlled trials and retrospective cohort studies sourced from key electronic databases. These studies specifically examined the effects of different PPIs, such as lansoprazole, esomeprazole, omeprazole, rabeprazole, and pantoprazole, when used in conjunction with clopidogrel on MACEs. The primary focus was on the differential impact of these PPIs, while the secondary focus was on the comparison of gastrointestinal (GI) bleeding events in groups receiving different PPIs with clopidogrel vs. a placebo group. This study's protocol was officially registered with INPLASY (INPLASY2024-2-0009).

Results: We conducted a network meta-analysis involving 16 studies with a total of 145,999 patients. Our findings indicated that rabeprazole when combined with clopidogrel, had the lowest increase in MACE risk (effect size, 1.05, 95% CI: 0.66-1.66), while lansoprazole was associated with the highest risk increase (effect size, 1.48, 95% CI: 1.22-1.80). Esomeprazole (effect size, 1.28, 95% CI: 1.09-1.51), omeprazole (effect size, 1.23, 95% CI: 1.07-1.43), and pantoprazole (effect size, 1.38, 95% CI: 1.18-1.60) also significantly increased MACE risk. For the secondary outcome, esomeprazole (effect size, 0.30, 95% CI: 0.09-0.94), omeprazole (effect size, 0.34, 95% CI: 0.14-0.81), and pantoprazole (effect size, 0.33, 95% CI: 0.13-0.84) demonstrated an increased potential for GI bleeding prevention.

Conclusions: In conclusion, the combination of lansoprazole and clopidogrel was found to significantly elevate the risk of MACEs without offering GI protection in post-PCI patients. This study is the first network meta-analysis to identify the most effective regimen for the concurrent use of clopidogrel with individual PPIs.

Systematic review registration: https://inplasy.com/inplasy-2024-2-0009/, identifier (INPLASY2024-2-0009).

Keywords: clopidogrel; gastrointestinal (GI) bleeding; major adverse cardiovascular events (MACEs); post-percutaneous coronary intervention (PCI); proton pump inhibitors (PPIs).

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Network plots illustrate the effects of different PPIs concurrent with clopidogrel on MACE risk. The size of each node and thickness of each line represent the number of trials included in the analysis.
Figure 3
Figure 3
Forest plots illustrating the risk ratio (RR) of MACEs in clopidogrel concurrent with different PPIs and placebo groups among post-PCI patients.
Figure 4
Figure 4
Forest plots of the risk ratio (RR) of GI bleeding in clopidogrel concurrent with different PPIs and placebo groups among post-PCI patients.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Pant S, Neupane P, Ramesh K, Barakoti M. Post percutaneous coronary intervention antiplatelet therapy: current perceptions, prospects and perplexity. Cardiol J. (2011) 18:712–7. 10.5603/cj.2011.0042 - DOI - PubMed
    1. Natsuaki M, Kimura T. Antiplatelet therapy after percutaneous coronary intervention—past, current and future perspectives—. Circ J. (2022) 86:741–7. 10.1253/circj.CJ-21-0751 - DOI - PubMed
    1. Fanaroff A, Rao S. Antiplatelet therapy in PCI. Interv Cardiol Clin. (2016) 5:221.383. 10.1016/j.iccl.2015.12.007 - DOI - PMC - PubMed
    1. Cho S, Kang D-Y, Kim J-S, Park D-W, Kim I-S, Kang TS, et al. Dual antiplatelet therapy after percutaneous coronary intervention for left main coronary artery disease. Rev Esp Cardiol (Engl Ed). (2023) 76:245–52. 10.1016/j.rec.2022.07.007 - DOI - PubMed
    1. Faxon DP, Lawler E, Young M, Gaziano M, Kinlay S. Prolonged clopidogrel use after bare metal and drug-eluting stent placement: the veterans administration drug-eluting stent study. Circ Cardiovasc Interventions. (2012) 5:372–80. 10.1161/CIRCINTERVENTIONS.111.967257 - DOI - PubMed

Publication types

LinkOut - more resources