The potential interaction between clopidogrel and proton pump inhibitors: a systematic review
<p>Abstract</p> <p>Background</p> <p>Recently, several publications have investigated a possible drug interaction between clopidogrel and proton pump inhibitors (PPIs), and regulatory agencies have issued warnings despite discordant study results. In an attempt to clari...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2010-12-01
|
| Series: | BMC Medicine |
| Online Access: | http://www.biomedcentral.com/1741-7015/8/81 |
| _version_ | 1811251193875267584 |
|---|---|
| author | Brophy James M Lima Joao |
| author_facet | Brophy James M Lima Joao |
| author_sort | Brophy James M |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Recently, several publications have investigated a possible drug interaction between clopidogrel and proton pump inhibitors (PPIs), and regulatory agencies have issued warnings despite discordant study results. In an attempt to clarify the situation, we performed a systematic review with a critical analysis of study methodologies to determine whether varying study quality (that is, bias) could explain the discordant results.</p> <p>Methods</p> <p>A systematic review of all studies reporting clinical outcomes was performed using an electronic literature search of the MEDLINE and EMBASE databases, abstracts from the major cardiology conferences and a hand-search of bibliographies from identified articles. Each study was evaluated for its risk of bias according to a prespecified quality measure scale.</p> <p>Results</p> <p>A total of 18 studies were identified. Ten of 13 studies judged to be of low scientific quality reported a statistically positive interaction between clopidogrel and the general class of PPIs, and each concluded this was likely a clinically meaningful effect. None of the five studies judged to be of moderate or high quality reported a statistically significant association. Multiple sources of heterogeneity (that is, different populations, outcomes assessed, drug exposure methods and study quality) prevented a formal quantitative analysis of all studies. An increased risk of bias was observed in the positive studies, resulting in an inverse correlation between study quality and a reported statistically positive interaction (10/13 versus 0/5; <it>P </it>= p = 0.007). There was also no clinical evidence for a positive interaction according to specific PPIs.</p> <p>Conclusion</p> <p>The observed association between clopidogrel and PPIs is found uniquely in studies judged to be of low quality and with an increased risk of bias. High-quality evidence supporting a clinically significant clopidogrel/PPI interaction is presently lacking.</p> |
| first_indexed | 2024-04-12T16:15:56Z |
| format | Article |
| id | doaj.art-e459fce61a2e4c1daf038398e59524d8 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-04-12T16:15:56Z |
| publishDate | 2010-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-e459fce61a2e4c1daf038398e59524d82022-12-22T03:25:43ZengBMCBMC Medicine1741-70152010-12-01818110.1186/1741-7015-8-81The potential interaction between clopidogrel and proton pump inhibitors: a systematic reviewBrophy James MLima Joao<p>Abstract</p> <p>Background</p> <p>Recently, several publications have investigated a possible drug interaction between clopidogrel and proton pump inhibitors (PPIs), and regulatory agencies have issued warnings despite discordant study results. In an attempt to clarify the situation, we performed a systematic review with a critical analysis of study methodologies to determine whether varying study quality (that is, bias) could explain the discordant results.</p> <p>Methods</p> <p>A systematic review of all studies reporting clinical outcomes was performed using an electronic literature search of the MEDLINE and EMBASE databases, abstracts from the major cardiology conferences and a hand-search of bibliographies from identified articles. Each study was evaluated for its risk of bias according to a prespecified quality measure scale.</p> <p>Results</p> <p>A total of 18 studies were identified. Ten of 13 studies judged to be of low scientific quality reported a statistically positive interaction between clopidogrel and the general class of PPIs, and each concluded this was likely a clinically meaningful effect. None of the five studies judged to be of moderate or high quality reported a statistically significant association. Multiple sources of heterogeneity (that is, different populations, outcomes assessed, drug exposure methods and study quality) prevented a formal quantitative analysis of all studies. An increased risk of bias was observed in the positive studies, resulting in an inverse correlation between study quality and a reported statistically positive interaction (10/13 versus 0/5; <it>P </it>= p = 0.007). There was also no clinical evidence for a positive interaction according to specific PPIs.</p> <p>Conclusion</p> <p>The observed association between clopidogrel and PPIs is found uniquely in studies judged to be of low quality and with an increased risk of bias. High-quality evidence supporting a clinically significant clopidogrel/PPI interaction is presently lacking.</p>http://www.biomedcentral.com/1741-7015/8/81 |
| spellingShingle | Brophy James M Lima Joao The potential interaction between clopidogrel and proton pump inhibitors: a systematic review BMC Medicine |
| title | The potential interaction between clopidogrel and proton pump inhibitors: a systematic review |
| title_full | The potential interaction between clopidogrel and proton pump inhibitors: a systematic review |
| title_fullStr | The potential interaction between clopidogrel and proton pump inhibitors: a systematic review |
| title_full_unstemmed | The potential interaction between clopidogrel and proton pump inhibitors: a systematic review |
| title_short | The potential interaction between clopidogrel and proton pump inhibitors: a systematic review |
| title_sort | potential interaction between clopidogrel and proton pump inhibitors a systematic review |
| url | http://www.biomedcentral.com/1741-7015/8/81 |
| work_keys_str_mv | AT brophyjamesm thepotentialinteractionbetweenclopidogrelandprotonpumpinhibitorsasystematicreview AT limajoao thepotentialinteractionbetweenclopidogrelandprotonpumpinhibitorsasystematicreview AT brophyjamesm potentialinteractionbetweenclopidogrelandprotonpumpinhibitorsasystematicreview AT limajoao potentialinteractionbetweenclopidogrelandprotonpumpinhibitorsasystematicreview |