Impact of concomitant treatment with proton pump inhibitors and clopidogrel on clinical outcome in patients after coronary stent implantation

Ioannis Tentzeris; Rudolf Jarai; Serdar Farhan; Ivan Brozovic; Peter Smetana; Alexander Geppert; Johann Wojta; Jolanta Siller-Matula; Kurt Huber

doi:10.1160/TH10-04-0218

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2010; 104(06): 1211-1218
DOI: 10.1160/TH10-04-0218

Platelets and Blood Cells

Schattauer GmbH

Impact of concomitant treatment with proton pump inhibitors and clopidogrel on clinical outcome in patients after coronary stent implantation

Ioannis Tentzeris

¹3^rd Medical Department with Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria

,

Rudolf Jarai

¹3^rd Medical Department with Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria

,

Serdar Farhan

¹3^rd Medical Department with Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria

,

Ivan Brozovic

¹3^rd Medical Department with Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria

,

Peter Smetana

¹3^rd Medical Department with Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria

,

Alexander Geppert

¹3^rd Medical Department with Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria

,

Johann Wojta

²Department of Cardiology, Medical University of Vienna, Vienna, Austria

,

Jolanta Siller-Matula

³Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria

,

Kurt Huber

¹3^rd Medical Department with Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria

› Author Affiliations

Abstract

Summary

The aim of the study was to evaluate the effect of the concomitant treatment with proton-pump inhibitors (PPIs) and clopidogrel on the incidence of stent thrombosis, acute coronary syndrome (ACS) and death in patients who underwent percutaneous coronary intervention (PCI) and stent implantation. In total, 1,210 patients under dual anti-platelet therapy, who underwent PCI and stent implantation, were included in a prospective registry from January 2003 until December 2006. The patients were divided retrospectively into those with or without long-term PPI treatment (for the duration of dual antiplatelet therapy). All-cause mortality, cardiovascular death, re-hospitalisation for reACS, stent thrombosis, as well as the combined endpoint all-cause death, re-ACS or stent thrombosis were evaluated over a mean follow-up period of 7.8 (± 3.63) months (range 1–12 months). Propensity score analysis was performed to reduce potential selection bias and exhibited no significant difference between the two study groups with respect to all-cause mortality, cardiovascular death, re-ACS, stent thrombosis and the combined endpoint. In pre-specified subgroup analyses performed in patients presenting with ACS and referred for acute PCI or for stable patients referred for elective PCI, receiving drug-eluting stents or bare metal stents, in diabetics or non-diabetics, in males or females, and in patients older than 75 years or ≤75 years of age use of PPIs had no significant impact on clinical outcome. Our data suggest that a combined use of clopidogrel as part of dual antiplatelet therapy (DAPT) after coronary stenting and PPIs does not significantly influence the clinical outcome.

Keywords

Stent implantation - clopidogrel - proton pump inhibitors - acute coronary syndrome - stent thrombosis

Full Text

References

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