PMID- 20102352
OWN - NLM
STAT- MEDLINE
DCOM- 20101206
LR  - 20220409
IS  - 1365-2036 (Electronic)
IS  - 0269-2813 (Linking)
VI  - 31
IP  - 8
DP  - 2010 Apr
TI  - Meta-analysis: the effects of proton pump inhibitors on cardiovascular events and 
      mortality in patients receiving clopidogrel.
PG  - 810-23
LID - 10.1111/j.1365-2036.2010.04247.x [doi]
AB  - BACKGROUND: Recent studies have suggested an adverse interaction between proton 
      pump inhibitors (PPI) and clopidogrel. AIM: To perform a meta-analysis of 
      cardiovascular outcomes and mortality in patients taking clopidogrel, with and 
      without concomitant PPI. METHODS: We searched MEDLINE, EMBASE, Cochrane 
      Controlled Trials Register in October 2009, and checked conference abstracts for 
      randomized and nonrandomized studies that reported the risk of cardiovascular 
      events and mortality with PPI exposure in patients taking clopidogrel. We 
      performed random effects meta-analysis, stratified by study design and assessed 
      heterogeneity using the I2 statistic. RESULTS: Our review included 23 studies 
      covering 93,278 patients. There was substantial heterogeneity in the 
      meta-analyses of major cardiovascular events (19 studies, I2 = 79%) or myocardial 
      infarction (12 studies, I2 = 77%). Analysis of propensity-matched or randomized 
      trial participants showed no associated cardiovascular risk with PPIs, whereas 
      other observational studies generally showed a significant association. 
      Meta-analysis of 13 studies showed no significant association between PPI use and 
      overall mortality (RR 1.09, 95% CI: 0.94-1.26, P = 0.23, I2 = 60%). CONCLUSION: 
      As there are conflicting and inconsistent data regarding the adverse 
      clopidogrel-PPI interaction, clinicians should focus on potential harm from 
      ulcers/haemorrhage before deciding to omit PPIs in patients taking clopidogrel.
FAU - Kwok, C S
AU  - Kwok CS
AD  - School of Medicine, Health Policy and Practice, University of East Anglia, 
      Norwich, Norfolk, UK.
FAU - Loke, Y K
AU  - Loke YK
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20100122
PL  - England
TA  - Aliment Pharmacol Ther
JT  - Alimentary pharmacology & therapeutics
JID - 8707234
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
SB  - IM
EIN - Aliment Pharmacol Ther. 2010 Sep;32(5):696
MH  - Aged
MH  - Cardiovascular Diseases/*chemically induced/mortality
MH  - Clopidogrel
MH  - Drug Interactions
MH  - Drug Therapy, Combination
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/*adverse effects
MH  - Proton Pump Inhibitors/*adverse effects
MH  - Randomized Controlled Trials as Topic
MH  - Risk Factors
MH  - Ticlopidine/adverse effects/*analogs & derivatives
MH  - Treatment Outcome
RF  - 37
EDAT- 2010/01/28 06:00
MHDA- 2010/12/14 06:00
CRDT- 2010/01/28 06:00
PHST- 2010/01/28 06:00 [entrez]
PHST- 2010/01/28 06:00 [pubmed]
PHST- 2010/12/14 06:00 [medline]
AID - APT4247 [pii]
AID - 10.1111/j.1365-2036.2010.04247.x [doi]
PST - ppublish
SO  - Aliment Pharmacol Ther. 2010 Apr;31(8):810-23. doi: 
      10.1111/j.1365-2036.2010.04247.x. Epub 2010 Jan 22.