Christopher B. Granger, MD
In older patients discharged from hospital after acute myocardial infarction (MI), does concomitant use of a proton-pump inhibitor (PPI) with clopidogrel lead to adverse events?
Population-based, nested, case–control study with 69-month follow-up.
13 636 patients who were ≥ 66 years of age (median age 76 y, 56% men) and had filled a prescription for clopidogrel within 3 days of hospital discharge after acute MI. Exclusion criteria were use of clopidogrel, ticlopidine, or dipyridamole in the year before admission; use of PPI combination products to eradicate Helicobacter pylori within 90 days of the index date (readmission for MI); or residence in a long-term care facility.
Prescription records were used to assess exposure to PPIs within 30 days (current), 31 to 90 days (previous), and 81 to 180 days (remote) of the index date.
Death or readmission for MI within 90 days of initial hospital discharge. Controls were matched to cases on age, receipt of percutaneous coronary intervention in hospital, date of hospital discharge, and predicted probability of short-term mortality based on a cardiac risk prediction model.
782 patients were readmitted for or died from MI within 90 days of initial discharge; 734 of these were matched to ≥ 1 control (2057 controls). Current (but not previous or remote) use of PPIs was associated with increased risk for readmission for or death from MI (Table).
In older patients discharged from hospital after acute myocardial infarction (MI), concomitant use of proton-pump inhibitors was associated with increased risk for readmission for or death from MI within 90 days of initial discharge.
Associations between use of PPIs and risk for hospital readmission for or death from MI in older patients taking clopidogrel after discharge for acute MI*
*MI = myocardial infarction; PPI = proton-pump inhibitor.
†Adjusted for age; sex; income; length of initial hospital stay; 9 medical conditions associated with short-term mortality after acute MI; and use of other commonly prescribed cardiovascular medications, other cytochrome P450 2C19 inhibitors or inducers, and other cytochrome P450 3A4 inhibitors or inducers.
Granger CB. Concomitant use of proton-pump inhibitors with clopidogrel may increase risk for readmission after discharge for acute MI. Ann Intern Med. ;151:JC2–13. doi: 10.7326/0003-4819-151-4-200908180-02013
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Published: Ann Intern Med. 2009;151(4):JC2-13.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine, Hospital Medicine.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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