Impact of Proton Pump Inhibitor Use on the Comparative Effectiveness and Safety of Prasugrel Versus Clopidogrel: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE‐ACS) Study
BackgroundProton pump inhibitors (PPIs) reduce gastrointestinal bleeding events but may alter clopidogrel metabolism. We sought to understand the comparative effectiveness and safety of prasugrel versus clopidogrel in the context of proton pump inhibitor (PPI) use. Methods and ResultsUsing data on 1...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2016-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.116.003824 |
| _version_ | 1811332298477404160 |
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| author | Larry R. Jackson Eric D. Peterson Lisa A. McCoy Christine Ju Marjorie Zettler Brian A. Baker John C. Messenger Douglas E. Faries Mark B. Effron David J. Cohen Tracy Y. Wang |
| author_facet | Larry R. Jackson Eric D. Peterson Lisa A. McCoy Christine Ju Marjorie Zettler Brian A. Baker John C. Messenger Douglas E. Faries Mark B. Effron David J. Cohen Tracy Y. Wang |
| author_sort | Larry R. Jackson |
| collection | DOAJ |
| description | BackgroundProton pump inhibitors (PPIs) reduce gastrointestinal bleeding events but may alter clopidogrel metabolism. We sought to understand the comparative effectiveness and safety of prasugrel versus clopidogrel in the context of proton pump inhibitor (PPI) use. Methods and ResultsUsing data on 11 955 acute myocardial infarction (MI) patients treated with percutaneous coronary intervention at 233 hospitals and enrolled in the TRANSLATE‐ACS study, we compared whether discharge PPI use altered the association of 1‐year adjusted risks of major adverse cardiovascular events (MACE; death, MI, stroke, or unplanned revascularization) and Global Use of Strategies To Open Occluded Arteries (GUSTO) moderate/severe bleeding between prasugrel‐ and clopidogrel‐treated patients. Overall, 17% of prasugrel‐treated and 19% of clopidogrel‐treated patients received a PPI at hospital discharge. At 1 year, patients discharged on a PPI versus no PPI had higher risks of MACE (adjusted hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.21‐1.58) and GUSTO moderate/severe bleeding (adjusted HR 1.55, 95% CI 1.15‐2.09). Risk of MACE was similar between prasugrel and clopidogrel regardless of PPI use (adjusted HR 0.88, 95% CI 0.62‐1.26 with PPI, adjusted HR 1.07, 95% CI 0.90‐1.28 without PPI, interaction P=0.31). Comparative bleeding risk associated with prasugrel versus clopidogrel use differed based on PPI use but did not reach statistical significance (adjusted HR 0.73, 95% CI 0.36‐1.48 with PPI, adjusted HR 1.34, 95% CI 0.79‐2.27 without PPI, interaction P=0.17). ConclusionsPPIs did not significantly affect the MACE and bleeding risk associated with prasugrel use, relative to clopidogrel. Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01088503. |
| first_indexed | 2024-04-13T16:34:42Z |
| format | Article |
| id | doaj.art-e690aeadd13b41f2870058ab1125d52d |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:34:42Z |
| publishDate | 2016-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-e690aeadd13b41f2870058ab1125d52d2022-12-22T02:39:28ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-10-0151010.1161/JAHA.116.003824Impact of Proton Pump Inhibitor Use on the Comparative Effectiveness and Safety of Prasugrel Versus Clopidogrel: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE‐ACS) StudyLarry R. Jackson0Eric D. Peterson1Lisa A. McCoy2Christine Ju3Marjorie Zettler4Brian A. Baker5John C. Messenger6Douglas E. Faries7Mark B. Effron8David J. Cohen9Tracy Y. Wang10Duke Clinical Research Institute, Duke University School of Medicine, Durham, NCDuke Clinical Research Institute, Duke University School of Medicine, Durham, NCDuke Clinical Research Institute, Duke University School of Medicine, Durham, NCDuke Clinical Research Institute, Duke University School of Medicine, Durham, NCEli Lilly & Company, Indianapolis, INDaiichi Sankyo, Inc, Parsippany, NJUniversity of Colorado School of Medicine, Aurora, COEli Lilly & Company, Indianapolis, INEli Lilly & Company, Indianapolis, INSaint Luke's Mid America Heart Institute, University of Missouri‐Kansas City School of Medicine, Kansas City, MODuke Clinical Research Institute, Duke University School of Medicine, Durham, NCBackgroundProton pump inhibitors (PPIs) reduce gastrointestinal bleeding events but may alter clopidogrel metabolism. We sought to understand the comparative effectiveness and safety of prasugrel versus clopidogrel in the context of proton pump inhibitor (PPI) use. Methods and ResultsUsing data on 11 955 acute myocardial infarction (MI) patients treated with percutaneous coronary intervention at 233 hospitals and enrolled in the TRANSLATE‐ACS study, we compared whether discharge PPI use altered the association of 1‐year adjusted risks of major adverse cardiovascular events (MACE; death, MI, stroke, or unplanned revascularization) and Global Use of Strategies To Open Occluded Arteries (GUSTO) moderate/severe bleeding between prasugrel‐ and clopidogrel‐treated patients. Overall, 17% of prasugrel‐treated and 19% of clopidogrel‐treated patients received a PPI at hospital discharge. At 1 year, patients discharged on a PPI versus no PPI had higher risks of MACE (adjusted hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.21‐1.58) and GUSTO moderate/severe bleeding (adjusted HR 1.55, 95% CI 1.15‐2.09). Risk of MACE was similar between prasugrel and clopidogrel regardless of PPI use (adjusted HR 0.88, 95% CI 0.62‐1.26 with PPI, adjusted HR 1.07, 95% CI 0.90‐1.28 without PPI, interaction P=0.31). Comparative bleeding risk associated with prasugrel versus clopidogrel use differed based on PPI use but did not reach statistical significance (adjusted HR 0.73, 95% CI 0.36‐1.48 with PPI, adjusted HR 1.34, 95% CI 0.79‐2.27 without PPI, interaction P=0.17). ConclusionsPPIs did not significantly affect the MACE and bleeding risk associated with prasugrel use, relative to clopidogrel. Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01088503.https://www.ahajournals.org/doi/10.1161/JAHA.116.003824bleeding riskclopidogrelmajor adverse cardiovascular eventsprasugrelproton pump inhibitors |
| spellingShingle | Larry R. Jackson Eric D. Peterson Lisa A. McCoy Christine Ju Marjorie Zettler Brian A. Baker John C. Messenger Douglas E. Faries Mark B. Effron David J. Cohen Tracy Y. Wang Impact of Proton Pump Inhibitor Use on the Comparative Effectiveness and Safety of Prasugrel Versus Clopidogrel: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE‐ACS) Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease bleeding risk clopidogrel major adverse cardiovascular events prasugrel proton pump inhibitors |
| title | Impact of Proton Pump Inhibitor Use on the Comparative Effectiveness and Safety of Prasugrel Versus Clopidogrel: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE‐ACS) Study |
| title_full | Impact of Proton Pump Inhibitor Use on the Comparative Effectiveness and Safety of Prasugrel Versus Clopidogrel: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE‐ACS) Study |
| title_fullStr | Impact of Proton Pump Inhibitor Use on the Comparative Effectiveness and Safety of Prasugrel Versus Clopidogrel: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE‐ACS) Study |
| title_full_unstemmed | Impact of Proton Pump Inhibitor Use on the Comparative Effectiveness and Safety of Prasugrel Versus Clopidogrel: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE‐ACS) Study |
| title_short | Impact of Proton Pump Inhibitor Use on the Comparative Effectiveness and Safety of Prasugrel Versus Clopidogrel: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE‐ACS) Study |
| title_sort | impact of proton pump inhibitor use on the comparative effectiveness and safety of prasugrel versus clopidogrel insights from the treatment with adenosine diphosphate receptor inhibitors longitudinal assessment of treatment patterns and events after acute coronary syndrome translate acs study |
| topic | bleeding risk clopidogrel major adverse cardiovascular events prasugrel proton pump inhibitors |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.116.003824 |
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