Abstract
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 METHOD: 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.
RESULT: Out of 464 patients, 175 (37.7%) were discharged on clopi- dogrel. 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 read- mission rates and was not associated with higher mortality compared with the non-PPI cohorts.
LIMITATIONS: Single center study, not generalizable. Given the ret-rospective nature of this study, we did not collect data on duration of treatments or patient compliance.