Impact of concomitant use of proton pump inhibitors and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome  

作　　者：Yan YAN Xiao WANG Jing-Yao FAN Shao-Ping NIE Sergio Raposeiras-Roubin Emad Abu-Assi Jose P Simao Henriques Fabrizio D'Ascenzo Jorge Saucedo Jose R Gonzfilez-Juanatey Stephen B Wilton Wouter J Kikkert Ivlin Nufiez-Gil Albert Ariza-Sole Xian-Tao SONG Dimitrios Alexopoulos Christoph Liebetrau Tetsuma Kawaji Claudio Moretti Zenon Huczek Toshiharu Fujii Luis C Correia Masa-aki Kawashiril Sasko Kedev 

机构地区：[1]Beijing Anzhen Hospital, Capital Medical University, Beijing, China [2]University Hospital.4lvaro Cunqueiro, Vigo, Spain [3]University Academic Medical Center, Amsterdam, the Netherlands [4]Dipartimento di Scienze Mediche, Divisione di Cardiologia. Citt& della Salute e della Scienza, Turin, Italy [5]NorthShore University Hospital Chicago. USA [6]University Clinical Hospital of Santiago de Compostela, Spain [7]Libin Cardiovascular Institute of Alberta, Calgary, Canada [8]San Carlos Hospital Madrid, Spain [9]Bellvitge Hospital, Barcelona, Spain [10]University Patras Hospital, Athens, Greece [11]Kerckhoff Heart and Thorax Center, Frankfurt, Germany [12]Graduate School of Medicine, Kyoto University, Kyoto, Japan [13]University Clinical Hospital, Warsaw, Poland [14]Tokai University School of Medicine, Tokyo, Japan [15]Hospital Sao RafaeL Salvador, Brazil [16]Kanazawa University Graduate School of Medicine, Kanazawa, Japan [17]University Clinic of Cardiology, Skopje, Macedonia

出　　处：《Journal of Geriatric Cardiology》2016年第3期209-217,共9页老年心脏病学杂志（英文版）

摘　　要：Background There is great debate on the possible adverse interaction between proton pump inhibitors （PPIs） and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomi- tant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome （ACS） after percuta- neous coronary intervention （PCI）. Methods We retrospectively analyzed data fi＇om a ＂real world＂, international, multi-center registry between 2003 and 2014 （n = 15,401） and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint （all-cause death, re-infarction, or severe bleeding） in patients with ACS after PCI. Results Of 9429 patients in the final cohort, 54.8% （n = 5165） was prescribed a PPI at discharge. Patients receiving a PPI were older, more often female, and were more likely to have comorbidities. No association was observed between PPI use and the primary endpoint for patients receiving clopidogrel （ad- justed HR： 1.036; 95% CI： 0.903-1.189） or ticagrelor （adjusted HR： 2.320; 95% CI： 0.875-45.151） （Pinteraction = 0.2004）. Similarly, use of a PPI was not associated with increased risk of all-cause death, re-infarction, or a decreased risk of severe bleeding for patients treated with either clopidogrel or ticagrelor. Conclusions In patients with ACS following PCI, concomitant use of PPIs was not associated with in- creased risk of adverse outcomes in patients receiving either clopidogrel or ticagrelor. Our findings indicate it is reasonable to use a PPI in combination with clopidogrel or ticagrelor, especially in patients with a higher risk of gastrointestinal bleeding.

关 键 词：Acute coronary syndrome CLOPIDOGREL OUTCOME Proton pump inhibitor Ticagrelor 

分 类 号：S858.28[农业科学—临床兽医学] Q51[农业科学—兽医学]