PMID- 20456741
OWN - NLM
STAT- MEDLINE
DCOM- 20100813
LR  - 20181201
IS  - 1365-2710 (Electronic)
IS  - 0269-4727 (Linking)
VI  - 35
IP  - 2
DP  - 2010 Apr
TI  - PPI use in patients commenced on clopidogrel: a retrospective cross-sectional 
      evaluation.
PG  - 213-7
LID - 10.1111/j.1365-2710.2009.01089.x [doi]
AB  - BACKGROUND/AIMS: Antiplatelet therapy with aspirin and clopidogrel is an 
      important component of the management of acute coronary syndrome, but it also 
      increases the risk of bleeding. There are no formal guidelines about the use of a 
      proton pump inhibitor (PPI) for gastroprotection in patients on clopidogrel. This 
      study assessed how many patients in the Royal Darwin Hospital (RDH) and the Royal 
      Hobart Hospital (RHH) prescribed clopidogrel and at risk of bleeding were 
      co-prescribed PPIs. METHODS: We conducted a retrospective cohort study using a 
      pharmacy database to select all patients commenced on clopidogrel in a 1-year 
      period. We identified all patients newly prescribed clopidogrel and determined 
      the proportion that had a risk factor for bleeding and also received a PPI. We 
      also assessed the effect of the use of PPIs on the number of reported bleeds. 
      RESULTS: The final study cohort consisted of 385 patients who had been newly 
      prescribed clopidogrel. Of all patients discharged on clopidogrel, 95.6% 
      (368/385) had >or=1 risk factor for bleeding. One hundred and twenty-eight of 
      these patients [128/368, (34.8%)] were discharged on a PPI. Patients on dual 
      antiplatelet therapy with an additional risk factor for bleeding and not 
      discharged on a PPI were more likely to develop a major bleed than patients on 
      dual antiplatelet therapy without a risk factor for bleeding not discharged on a 
      PPI (11.1% vs. 1.8%; P < 0.01). Patients on dual antiplatelet therapy with an 
      additional risk factor for bleeding not discharged on a PPI had a higher 
      probability (borderline significance) of major bleeding, compared with patients 
      on dual antiplatelet therapy with an additional risk factor for bleeding 
      discharged on a PPI [PPI: 1/60, (1.7%) vs. no PPI: 6/54, (11.1%); P = 0.05]. 
      CONCLUSIONS: Our results indicate that PPIs may only lower the probability of 
      major bleeding in patients treated with dual antiplatelet therapy, who possess 
      additional risk factor(s) for bleeding.
FAU - Luinstra, M
AU  - Luinstra M
AD  - Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, 
      Groningen, The Netherlands.
FAU - Naunton, M
AU  - Naunton M
FAU - Peterson, G M
AU  - Peterson GM
FAU - Bereznicki, L
AU  - Bereznicki L
LA  - eng
PT  - Journal Article
PL  - England
TA  - J Clin Pharm Ther
JT  - Journal of clinical pharmacy and therapeutics
JID - 8704308
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Aspirin/adverse effects/therapeutic use
MH  - Clopidogrel
MH  - Cohort Studies
MH  - Cross-Sectional Studies
MH  - Drug Therapy, Combination
MH  - Female
MH  - Gastrointestinal Hemorrhage/chemically induced/*prevention & control
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Northern Territory
MH  - Platelet Aggregation Inhibitors/*adverse effects/therapeutic use
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Tasmania
MH  - Ticlopidine/adverse effects/*analogs & derivatives/therapeutic use
MH  - Young Adult
EDAT- 2010/05/12 06:00
MHDA- 2010/08/14 06:00
CRDT- 2010/05/12 06:00
PHST- 2010/05/12 06:00 [entrez]
PHST- 2010/05/12 06:00 [pubmed]
PHST- 2010/08/14 06:00 [medline]
AID - JCP1089 [pii]
AID - 10.1111/j.1365-2710.2009.01089.x [doi]
PST - ppublish
SO  - J Clin Pharm Ther. 2010 Apr;35(2):213-7. doi: 10.1111/j.1365-2710.2009.01089.x.