Impact of concomitant use of proton pump inhibitors and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome

作     者：Yan YAN Xiao WANG Jing-Yao FAN Shao-Ping NIE Sergio Raposeiras-Roubin Emad Abu-Assi Jose P Simao Henriques Fabrizio D'Ascenzo Jorge Saucedo Jose R Gonzfilez-Juanatey Stephen B Wilton Wouter J Kikkert Ivlin Nufiez-Gil Albert Ariza-Sole Xian-Tao SONG Dimitrios Alexopoulos Christoph Liebetrau Tetsuma Kawaji Claudio Moretti Zenon Huczek Toshiharu Fujii Luis C Correia Masa-aki Kawashiril Sasko Kedev 

作者机构：Beijing Anzhen Hospital Capital Medical University Beijing China University Hospital.4lvaro Cunqueiro Vigo Spain University Academic Medical Center Amsterdam the Netherlands Dipartimento di Scienze Mediche Divisione di Cardiologia. Citt& della Salute e della Scienza Turin Italy NorthShore University Hospital Chicago. USA University Clinical Hospital of Santiago de Compostela Spain Libin Cardiovascular Institute of Alberta Calgary Canada San Carlos Hospital Madrid Spain Bellvitge Hospital Barcelona Spain University Patras Hospital Athens Greece Kerckhoff Heart and Thorax Center Frankfurt Germany Graduate School of Medicine Kyoto University Kyoto Japan University Clinical Hospital Warsaw Poland Tokai University School of Medicine Tokyo Japan Hospital Sao RafaeL Salvador Brazil Kanazawa University Graduate School of Medicine Kanazawa Japan University Clinic of Cardiology Skopje Macedonia 

出 版 物：《Journal of Geriatric Cardiology》 (老年心脏病学杂志（英文版）)

年 卷 期：2016年第13卷第3期

页      面：209-217页

核心收录：

学科分类：090603[农学-临床兽医学] 0710[理学-生物学] 071010[理学-生物化学与分子生物学] 081704[工学-应用化学] 07[理学] 08[工学] 0817[工学-化学工程与技术] 09[农学] 0906[农学-兽医学] 

主　　题：Acute coronary syndrome Clopidogrel Outcome Proton pump inhibitor Ticagrelor 

摘      要：Background There is great debate on the possible adverse interaction between proton pump inhibitors （PPIs） and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomi- tant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome （ACS） after percuta- neous coronary intervention （PCI）. Methods We retrospectively analyzed data fi＇om a ＂real world＂, international, multi-center registry between 2003 and 2014 （n = 15,401） and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint （all-cause death, re-infarction, or severe bleeding） in patients with ACS after PCI. Results Of 9429 patients in the final cohort, 54.8% （n = 5165） was prescribed a PPI at discharge. Patients receiving a PPI were older, more often female, and were more likely to have comorbidities. No association was observed between PPI use and the primary endpoint for patients receiving clopidogrel （ad- justed HR： 1.036; 95% CI： 0.903-1.189） or ticagrelor （adjusted HR： 2.320; 95% CI： 0.875-45.151） （Pinteraction = 0.2004）. Similarly, use of a PPI was not associated with increased risk of all-cause death, re-infarction, or a decreased risk of severe bleeding for patients treated with either clopidogrel or ticagrelor. Conclusions In patients with ACS following PCI, concomitant use of PPIs was not associated with in- creased risk of adverse outcomes in patients receiving either clopidogrel or ticagrelor. Our findings indicate it is reasonable to use a PPI in combination with clopidogrel or ticagrelor, especially in patients with a higher risk of gastrointestinal bleeding.