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Dig Dis Sci. 2012 May;57(5):1304-13. doi: 10.1007/s10620-011-2007-1. Epub 2011 Dec 25.

Lack of significant interactions between clopidogrel and proton pump inhibitor therapy: meta-analysis of existing literature.

Author information

1
Department of Medicine, Stanford University, Stanford, CA 94063, USA. lgersonmd@yahoo.com

Abstract

BACKGROUND:

Published data regarding the effect of concomitant clopidogrel and proton pump inhibitor (PPI) therapy on cardiovascular outcomes have been conflicting.

AIM:

To perform an updated meta-analysis in order to determine changes in risk differences (RD) between primary and secondary outcome analyses.

METHODS:

Primary analysis was based on definite vascular outcomes, including all cause mortality, cardiac death, myocardial infarction, and/or stroke. Secondary analysis also incorporated probable cardiac events, which included re-hospitalization for cardiac symptoms or revascularization procedures. RD were combined using a random-effects model.

RESULTS:

We reviewed 1,204 publications of which 26 studies (16 published articles, 10 abstracts) met inclusion criteria. The meta-analysis of outcomes from the two randomized controlled trials did not show an increased risk (RD 0.0, 95% CI -0.01, 0.01) for adverse outcomes. The meta-analysis of primary outcomes showed a RD of 0.02 (95% CI 0.01, 0.03) for all studies. The meta-analysis for secondary outcomes yielded a RD of 0.02 (95% CI 0.01-0.04) based on 19 published papers and abstracts. When primary and secondary outcomes were combined, the meta-analysis for published papers yielded an overall RD of 0.05 (95% CI 0.03-0.06).

CONCLUSIONS:

In patients using concomitant clopidogrel and PPI therapy, the risk of adverse cardiac outcomes was 0% based on data from well-controlled randomized trials. Data from retrospective studies and the addition of probable vascular events significantly increased the RD estimates, likely due to lack of adjustment for potential confounders.

PMID:
22198703
DOI:
10.1007/s10620-011-2007-1
[Indexed for MEDLINE]

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