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Adding Clopidogrel to PPIs Does Not Increase Cardio Risk

Use of PPIs in MI patients tied to higher risk; adding clopidogrel doesn't raise risk further

TUESDAY, Sept. 21 (HealthDay News) -- Proton-pump inhibitors (PPIs) are associated with an increased risk of adverse cardiovascular outcomes after discharge in patients hospitalized for myocardial infarction (MI); however, concomitant use of clopidogrel is not associated with any additional cardiovascular risk, according to a study in the Sept. 21 issue of the Annals of Internal Medicine.

Mette Charlot, M.D., of Copenhagen University Hospital Gentofte in Hellerup, Denmark, and colleagues evaluated 56,406 individuals hospitalized for MI to assess the risk of adverse cardiovascular outcomes associated with dual use of clopidogrel and PPIs.

The investigators found that 16.2 percent of patients were rehospitalized for MI or stroke, or experienced cardiovascular death. In addition, 27.3 percent of the 24,702 patients who received clopidogrel also received PPIs. Among the cohort assembled at day 30 after discharge, the hazard ratio for cardiovascular death or rehospitalization for MI or stroke for combined use of a PPI and clopidogrel was 1.29; the hazard ratio for use of a PPI alone was the same.

"As summarized by Charlot and colleagues, several other studies have been published on this subject, and -- despite conflicting results -- regulatory bodies have issued edicts that warn about a clinically significant drug interaction," write the authors of an accompanying editorial. "How, then, should clinicians interpret this conflicting body of evidence? We propose that a critical systematic review of all of the evidence would certainly help, but that a meta-analysis that combines studies of very uneven scientific quality would not."

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