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

Autor: Rahaf A. Alghamdi, Sina Marzoughi, Muath S. Alghamdi, Aisha Alghamdi, Mohammed Almekhlafi
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: Annals of Saudi Medicine, Vol 39, Iss 2, Pp 82-86 (2019)
Druh dokumentu: article
ISSN: 0256-4947
0975-4466
DOI: 10.5144/0256-4947.2019.82
Popis: BACKGROUND: Recent studies suggest a higher risk of adverse cardiovascular outcome and mortality in patients co-prescribed clopidogrel with proton pump inhibitors (PPI). OBJECTIVE: Investigate the impact of concomitant prescription of clopidogrel and PPI on 30-day unplanned readmission and one-year all-cause mortality. DESIGN: Retrospective longitudinal cohort study. SETTING: Single academic tertiary center. PATIENTS AND METHODS: The study included patients admitted with a diagnosis of ischemic or hemorrhagic stroke between 2010 and 2014. Demographic and outcome data were collected and compared for patients on clopidogrel plus PPI vs those on clopidogrel plus H2-blockers and those not on clopidogrel. MAIN OUTCOME MEASURES: One-year mortality and 30-day unplanned readmissions were compared among different patient groups using multivariable logistic regression modeling. SAMPLE SIZE: 464 patients. RESULTS: Out of 464 patients, 175 (37.7%) were discharged on clopidogrel. The concomitant prescription of clopidogrel and PPI was noted in 107 (24.4%) and clopidogrel and H2 blockers in 36 patients (7.8%). The one-year all-cause mortality in the entire cohort was 22.2%. Patients on clopidogrel plus PPI did not have a higher risk of one-year mortality compared to the non-PPI cohort (6.2% vs. 4.8%, p 0.7). There was a non-significant suggestion of lower one-year mortality in patients on clopidogrel plus PPI vs those not on clopidogrel (6.2% vs. 10.1%, p 0.23). In multivariable logistic regression, the use of clopidogrel plus PPI did not predict higher one-year mortality (odds ratio 0.6, P=0.6). The risk of unplanned 30-day readmission was lower in those with clopidogrel plus PPI (odds ratio 0.6, P=.03). CONCLUSION: The use of clopidogrel plus PPI resulted in lower readmission rates and was not associated with higher mortality compared with the non-PPI cohorts. LIMITATIONS: Single center study, not generalizable. Given the retrospective nature of this study, we did not collect data on duration of treatments or patient compliance. CONFLICT OF INTEREST: None.
Databáze: Directory of Open Access Journals
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