Proton pump inhibitors in patients treated with aspirin and clopidogrel

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The Danish civil registry and the national causes of death registry keep information on vital status and causes of death.

Participants All aspirin treated patients surviving 30 days after a first myocardial infarction from towith follow-up for one year. Main outcome measures The risk of the combined end point of cardiovascular death, myocardial infarction, or stroke associated with use of proton pump inhibitors was analysed using Kaplan-Meier analysis, Cox proportional hazard models, and propensity score matched Cox proportional hazard models.

The results of recent studies on whether treatment with proton pump inhibitors significantly influences aspirin induced inhibition of platelet aggregation have been conflicting. Methods We carried out a retrospective complete nationwide study based on information from four Danish national registers.

Income group was defined by the individual average yearly gross income during a five year period before study inclusion, and patients were divided into fifths according to their income. Influence of omeprazole on the antiplatelet action of clopidogrel associated to aspirin. To further assess the robustness of our results we did a series of additional analyses, including an analysis using the method by Schneeweiss that evaluates how large the effect of an unmeasured confounder or combination of confounders would need to be account for the results, 14 together with analysis of high risk patient subgroups, analysis dependent on subtype of proton pump inhibitor, a dose dependent analysis, and an analysis of the effect of concomitant use of non-steroidal anti-inflammatory drugs.

MC and CT-P obtained funding. We identified all consecutive patients, aged 30 years or more, admitted to hospital with a first myocardial infarction ICD codes II22 as a primary or secondary diagnosis between and Although the study is sponsored by industry, all the analysis and the data management have been independently performed by academic scientists.

Exceptions were aspirin and H 2 receptor blockers.

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In addition, high on-treatment platelet reactivity has been associated with recurrent ischemic events. The increased risk was not observed in patients treated with H 2 receptor blockers. To define high risk subgroups of patients, we used the concomitant use of loop diuretics or drugs for diabetes as a proxy for heart failure and diabetes, respectively. JAMA ; Focus on this area, including the implication of this study for the discussion on clopidogrel and proton pump inhibitors is warranted owing to the large clinical implications of a possible interaction between proton pump inhibitors and aspirin.

Results from the time dependent propensity score matched Cox proportional hazards regression analysis see fig 3 showed no difference in risk associated with different subtypes of proton pump inhibitors. Gastroenterology ; We carried out a retrospective complete nationwide study based on information from four Danish national registers.

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J Thromb Haemost ; 4: Dual antiplatelet therapy with aspirin and clopidogrel is associated with a significant reduction in vascular ischemic events; however, gastrointestinal bleeding events are a major concern in high-risk and older patients. Do proton pump inhibitors attenuate the effect of aspirin on platelet aggregation?

Background

We found a significant effect of treatment with proton pump inhibitors on cardiovascular outcomes for patients treated with aspirin. Use of proton pump inhibitors during follow-up was again included as a time dependent covariate. Every resident in Denmark is provided with a permanent and unique civil registration number at birth, enabling linkage between registers at individual level.

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Guidelines recommend dual antiplatelet therapy with aspirin and clopidogrel after myocardial infarction.

Objective To examine the effect of proton pump inhibitors on adverse cardiovascular events in aspirin treated patients with first time myocardial infarction. Research Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction: The GI end point is clinically relevant.

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