Abstract 5492: Risk of Major Adverse Cardiovascular Events in Patients on Clopidogrel and Proton Pump Inhibitors: A Meta-analysis
Background: The anti-platelet properties of clopidogrel are thought to be activated by cytochrome P450 2C19. This isoenzyme is potently inhibited by the most commonly prescribed proton pump inhibitors (PPIs) and therefore may interfere with clopidogrel activation and its anti-platelet effects. However, recently published studies have yielded mixed results, leaving the question unanswered. Hence a meta-analysis was performed to evaluate the potential impact of PPIs on the effectiveness of clopidogrel to prevent major adverse cardiovascular events (MACE).
Methods: A systematic review of literature revealed 5 studies involving 29749 patients. End points analyzed were major adverse cardiovascular events (acute myocardial infarction, repeat revascularization, death due to cardiac causes. Combined relative risks (RR) across all the studies and the 95% confidence intervals were computed using the Mantel-Haenszel fixed-effect model. A two-sided alpha error < 0.05 was considered to be statistically significant.
Results: There were no significant differences in patient demographics between both groups. Compared with patients on clopidogrel without PPI, the risk of MACE was significantly higher in patients taking clopidogrel with PPI (RR: 1.65, CI: 1.55 – 1.76; p=0.000).
Conclusions: The present meta-analysis suggests that combinig PPI with clopidogrel increases risk of MACE and it may be a class effect.