Effect of proton pump inhibitors on clinical outcome in patients treated with clopidogrel: a systematic review and meta-analysis

摘要: To investigate whether proton pump inhibitors (PPIs) negatively affect clinical outcome in patients treated with clopidogrel. Systematic review and meta-analysis. Outcomes evaluated were combined major adverse cardiac events (MACE), myocardial infarction (MI), stent thrombosis, death gastrointestinal bleeding. Studies included randomized trials or post-hoc analyzes of observational studies reporting adjusted effect estimates. Twenty five met the selection criteria 159 138 patients. Administration PPIs together clopidogrel corresponded to a 29% increased risk cardiovascular [risk ratio (RR) = 1.29, 95% confidence intervals (CI) 1.15-1.45] 31% MI (RR 1.31, 95%CI 1.12-1.53). In contrast, PPI use did not influence mortality 1.04, 0.93-1.16), whereas developing bleed under treatment decreased by 50% 0.50, CI 0.37-0.69). The presence significant heterogeneity might indicate that evidence is biased, confounded inconsistent. sensitivity analysis, however, yielded direction remained unchanged irrespective publication type, study quality, size an event. Two have negative exposure. conclusion, concomitant be associated but does death. Prospective are required cause-and-effect relationship truly exists explore different worsen as PPI-clopidogrel drug-drug interaction seem class effect.