Copenhagen University Hospital Gentofte, Hellerup, Denmark.
Ann Intern Med. 2010 Sep 21;153(6):378-86. doi: 10.7326/0003-4819-153-6-201009210-00005.
Controversy remains on whether the dual use of clopidogrel and proton-pump inhibitors (PPIs) affects clinical efficacy of clopidogrel.
To examine the risk for adverse cardiovascular outcomes related to concomitant use of PPIs and clopidogrel compared with that of PPIs alone in adults hospitalized for myocardial infarction.
A nationwide cohort study based on linked administrative registry data.
All hospitals in Denmark.
All patients discharged after first-time myocardial infarction from 2000 to 2006.
The primary outcome was a composite of rehospitalization for myocardial infarction or stroke or cardiovascular death. Patients were examined at several assembly time points, including 7, 14, 21, and 30 days after myocardial infarction. Follow-up was 1 year.
Of 56 406 included patients, 9137 (16.2%) were re-hospitalized for myocardial infarction or stroke or experienced cardiovascular death. Of the 24 702 patients (43.8%) who received clopidogrel, 6753 (27.3%) received concomitant PPIs. The hazard ratio for cardiovascular death or rehospitalization for myocardial infarction or stroke for concomitant use of a PPI and clopidogrel among the cohort assembled at day 30 after discharge was 1.29 (95% CI, 1.17 to 1.42). The corresponding ratio for use of a PPI in patients who did not receive clopidogrel was 1.29 (CI, 1.21 to 1.37). No statistically significant interaction occurred between a PPI and clopidogrel (P = 0.72).
Unmeasured and residual confounding, time-varying measurement errors of exposure, and biases from survival effects were possible.
Proton-pump inhibitors seem to be associated with increased risk for adverse cardiovascular outcomes after discharge, regardless of clopidogrel use for myocardial infarction. Dual PPI and clopidogrel use was not associated with any additional risk for adverse cardiovascular events over that observed for patients prescribed a PPI alone.
关于氯吡格雷与质子泵抑制剂（PPIs）的双重使用是否会影响氯吡格雷的临床疗效，目前仍存在争议。
在因心肌梗死住院的成年人中，与单独使用 PPI 相比，同时使用 PPI 和氯吡格雷是否会增加不良心血管结局的风险。
基于关联行政登记数据的全国性队列研究。
丹麦所有医院。
2000 年至 2006 年首次因心肌梗死出院的所有患者。
主要结局为因心肌梗死、中风或心血管死亡再次住院的复合结局。患者在几个集合时间点进行检查，包括心肌梗死后 7、14、21 和 30 天。随访时间为 1 年。
在纳入的 56406 例患者中，有 9137 例（16.2%）因心肌梗死、中风或心血管死亡再次住院。在接受氯吡格雷治疗的 24702 例患者（43.8%）中，有 6753 例（27.3%）同时使用了 PPI。出院后第 30 天集合队列中，同时使用 PPI 和氯吡格雷的心血管死亡或因心肌梗死或中风再次住院的风险比为 1.29（95%CI，1.17 至 1.42）。未使用氯吡格雷的患者使用 PPI 的相应比值为 1.29（CI，1.21 至 1.37）。PPI 和氯吡格雷之间未发生统计学显著交互作用（P = 0.72）。
可能存在未测量和残余混杂、暴露的时变测量误差以及生存效应的偏倚。
无论是否因心肌梗死而使用氯吡格雷，PPI 的使用似乎与出院后不良心血管结局风险的增加相关。与单独使用 PPI 的患者相比，同时使用 PPI 和氯吡格雷不会增加不良心血管事件的风险。
