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Outcome of stroke patients on clopidogrel plus proton-pump inhibitors: a single-center cohort study

Rahaf A Alghamdi, Sina Marzoughi, Muath S Alghamdi

    Annals of Saudi Medicine
    |April 8, 2019
    PubMed

    Insights

    Co-prescribing clopidogrel with proton pump inhibitors (PPI) did not increase mortality risk in stroke patients. This combination was associated with lower 30-day unplanned readmission rates.

    Area of Science:

    • Cardiology
    • Pharmacology
    • Clinical Medicine

    Background:

    • Recent studies indicate a potential increased risk of adverse cardiovascular events and mortality when clopidogrel is co-prescribed with proton pump inhibitors (PPIs).
    • This raises concerns regarding the safety of this common drug combination, particularly in vulnerable patient populations.

    Purpose of the Study:

    • To investigate the impact of concomitant clopidogrel and PPI use on 30-day unplanned hospital readmissions and one-year all-cause mortality.
    • To compare outcomes between patients receiving clopidogrel with PPIs, clopidogrel with H2 blockers, and clopidogrel without gastric acid suppressants.

    Main Methods:

    • A retrospective longitudinal cohort study was conducted at a single academic tertiary center.
    • Data from 464 patients admitted with stroke between 2010 and 2014 were analyzed.
    • Outcomes, including one-year mortality and 30-day unplanned readmissions, were compared using multivariable logistic regression.

    Main Results:

    • Among 175 patients discharged on clopidogrel, 107 received PPIs and 36 received H2 blockers.
    • Clopidogrel plus PPI use was not associated with increased one-year mortality (6.2% vs. 4.8% in non-PPI cohort; OR 0.6, P=0.6).
    • The clopidogrel plus PPI group showed a significantly lower risk of 30-day unplanned readmission (OR 0.6, P=0.03).

    Conclusions:

    • Concomitant use of clopidogrel and PPIs in stroke patients was not linked to higher mortality rates.
    • This drug combination was associated with reduced 30-day unplanned readmission rates.
    • Limitations include the single-center nature and retrospective design, precluding generalizability and analysis of treatment duration or compliance.
    Abstract

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