Comment on “Individual Proton Pump Inhibitors and Outcomes in Patients With Coronary Artery Disease on Dual Antiplatelet Therapy: A Systematic Review”
Abstract
Background:Observational studies evaluating the possible interaction between proton pump inhibitors (PPIs) and clopidogrel have shown mixed results.We conducted a systematic review comparing the safety of individual PPIs in patients with coronary artery disease taking clopidogrel. Methods and Results:Studies performed from January 1995 to December 2013 were screened for inclusion.Data were extracted, and study quality was graded for 34 potential studies.For those studies in which follow-up period, outcomes, and multivariable adjustment were comparable, meta-analysis was performed.The adjusted odds or hazard ratios for the composite of cardiovascular or all-cause death, myocardial infarction, and stroke at 1 year were reported in 6 observational studies with data on individual PPIs.Random-effects meta-analyses of the 6 studies revealed an increased risk for adverse cardiovascular events for those taking pantoprazole (hazard ratio 1.38; 95% CI 1.12---1.70),lansoprazole (hazard ratio 1.29; 95% CI 1.09---1.52),or esomeprazole (hazard ratio 1.27; 95% CI 1.02---1.58)compared with patients on no PPI.This association was not significant for omeprazole (hazard ratio 1.16; 95% CI 0.93---1.44).Sensitivity analyses for the coronary
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