Histamine2-receptor antagonists are an alternative to proton pump inhibitor in patients receiving clopidogrel.
Gastroenterology
; 139(4): 1165-71, 2010 Oct.
Article
em En
| MEDLINE
| ID: mdl-20600012
ABSTRACT
BACKGROUND & AIMS:
Previous observational studies reported that concomitant use of clopidogrel and proton pump inhibitors (PPIs) in patients with prior acute coronary syndrome (ACS) was associated with adverse cardiovascular outcomes. We investigated whether H(2)-receptor antagonist (H(2)RA) is an alternative to PPI in patients with ACS.METHODS:
We conducted a population-based retrospective cohort study of 6552 patients in Taiwan discharged for ACS between 2002 and 2005. Patients were divided into 5 cohorts clopidogrel plus H(2)RA (n = 252), clopidogrel plus PPI (n = 311), clopidogrel alone (n = 5551), H(2)RA alone (n = 235), and PPI alone (n = 203). The primary outcome was rehospitalization for ACS or all-cause mortality within 3 month of rehospitalization.RESULTS:
The 1-year cumulative incidence of the primary outcome was 26.8% (95% CI 21.5%-33.0%) in the clopidogrel plus H(2)RA cohort and 33.2% (95% CI 27.8%-39.4%) in the clopidogrel plus PPI cohort, compared with 11.6% (95% CI 10.8%-12.5%) in the clopidogrel alone cohort (P < .0001). No significant difference was observed between the PPI alone cohort (11.0%; 95% CI 7.1%-16.8%), the H(2)RA alone cohort (11.8%; 95% CI 8.2%-16.8%), and the clopidogrel alone cohort in terms of the primary outcome. The number needed to harm was 7 with concomitant H(2)RA and 5 with concomitant PPI. On multivariate analysis, concomitant H(2)RA and PPI were independent risk factors predicting adverse outcomes (adjusted hazard ratios, 2.48 and 3.20, respectively; P < .0001).CONCLUSIONS:
Concomitant use of clopidogrel and H(2)RA or PPI after hospital discharge for ACS is associated with increased risk of adverse outcomes.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ticlopidina
/
Inibidores da Agregação Plaquetária
/
Síndrome Coronariana Aguda
/
Inibidores da Bomba de Prótons
/
Antagonistas dos Receptores H2 da Histamina
Tipo de estudo:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
Idioma:
En
Revista:
Gastroenterology
Ano de publicação:
2010
Tipo de documento:
Article
País de afiliação:
Taiwan