Abstract 4147138: Cardiovascular and Bleeding Outcomes of Proton-Pump Inhibitor and Clopidogrel Co-therapy after Percutaneous Intervention: A Meta-Analysis

Introduction: Clinical studies have shown conflicting results regarding the effect of proton pump inhibitors (PPIs) on the antiplatelet action of clopidogrel in coronary artery disease (CAD) patients. We conducted a meta-analysis to evaluate cardiovascular, gastrointestinal, and mortality outcomes in 6 months of concurrent use of these medications. Methods: We searched PubMed and Embase, screened 1071 articles, and included seven articles meeting our inclusion criteria: randomized control trials comparing the PPI group to the control group (no PPI) in patients on clopidogrel with CAD for six months. The outcomes of interest were major adverse cardiovascular events (MACE), myocardial infarction (MI), heart failure (HF), arrhythmia, bleeding, all-cause death, and cardiovascular (CV) death. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effects model. We assessed heterogeneity between studies and p-value was assigned to <0.05 for statistical significance. Results: Seven studies with a total of 5146 patients (PPI group: 2585, No-PPI: 2561). Our analysis shows that use of PPI with clopidogrel is associated with less bleeding outcomes (RR: 0.30, CI:0.19-0.49; p-value:<0.0001). Table 1. Our analysis showed no difference with regard to myocardial infarction (RR: 0.96; CI: 0.51-1.79, p-value:0.897), major cardiovascular events (RR: 0.99; CI: 0.74-1.32, p-value: 0.944), the onset of heart failure (RR: 0.78; CI: 0.27-2.25, p-value: 0.643), arrhythmias (RR: 0.86; CI: 0.30-2.43, p-value: 0.775), cardiovascular mortality (RR: 0.78; CI: 0.29-2.07, p-value: 0.623), and all-cause mortality (RR: 0.77; CI: 0.39-1.51, p-value: 0.451). Figure 1. Conclusions: In patients taking clopidogrel, proton pump inhibitors are associated with decreased bleeding outcomes. Our study showed no difference in terms of cardiovascular and mortality outcomes. Further randomized controlled trials are needed to evaluate these results.