Abstract 5607: Risk of Re-hospitalization for Patients Using Clopidogrel With a Proton Pump Inhibitor
Background: Recent pharmacodynamic and retrospective clinical analyses have suggested that proton pump inhibitors (PPIs) may modify the antiplatelet effects of clopidogrel.
Methods: We conducted a retrospective cohort study of persons enrolled in a large multi-state health insurance plan with commercial and Medicare clients to evaluate adverse clinical outcomes for patients using clopidogrel plus PPI compared to clopidogrel alone. Using propensity scoring methodology, patients discharged from the hospital for myocardial infarction (MI) or coronary stent placement and treated with clopidogrel plus PPI were matched 1:1 with patients with similar cardiovascular risk factors treated with clopidogrel alone. Re-hospitalizations for MI or coronary stent placement were evaluated over a period of up to 360 days. A subanalysis was conducted to study the impact of pantoprazole, the most prescribed PPI.
Results: Rates of re-hospitalization for MI or coronary stent placement were higher for clopidogrel plus PPI versus clopidogrel alone (Table⇓). Patients receiving clopidogrel plus PPI had 92% higher risk of re-hospitalization for MI and 53% higher risk of re-hospitalization for MI or coronary stent placement than patients receiving clopidogrel alone. Increased risk of re-hospitalization for MI or coronary stent placement was also observed for the subgroup of clopidogrel plus PPI patients receiving pantoprazole.
Conclusion: Patients receiving clopidogrel plus PPI had significantly higher risk of re-hospitalization for MI or coronary stent placement than patients receiving clopidogrel alone. Prospective clinical trials and laboratory analyses of biochemical interactions are warranted to further evaluate the potential impact of PPIs on the efficacy of clopidogrel.