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Association of Prot...
Association of Proton Pump Inhibitor Use on Cardiovascular Outcomes With Clopidogrel and Ticagrelor : Outcomes With Clopidogrel and Ticagrelor
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Goodman, Shaun G. (author)
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Clare, Robert (author)
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Pieper, Karen S. (author)
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Nicolau, Jose C. (author)
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Storey, Robert F. (author)
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Cantor, Warren J. (author)
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Mahaffey, Kenneth W. (author)
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Angiolillo, Dominick J. (author)
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Husted, Steen (author)
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Cannon, Christopher P. (author)
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- James, Stefan K, 1964- (author)
- Uppsala universitet,Institutionen för medicinska vetenskaper,Uppsala kliniska forskningscentrum (UCR),Kardiologi
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Kilhamn, Jan (author)
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Steg, P. Gabriel (author)
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Harrington, Robert A. (author)
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- Wallentin, Lars, 1943- (author)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),kardiologi
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(creator_code:org_t)
- 2012
- 2012
- English.
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In: Circulation. - 0009-7322 .- 1524-4539. ; 125:8, s. 978-986
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Background-The clinical significance of the interaction between clopidogrel and proton pump inhibitors (PPIs) remains unclear. Methods and Results-We examined the relationship between PPI use and 1-year cardiovascular events (cardiovascular death, myocardial infarction, or stroke) in patients with acute coronary syndrome randomized to clopidogrel or ticagrelor in a prespecified, nonrandomized subgroup analysis of the Platelet Inhibition and Patient Outcomes (PLATO) trial. The primary end point rates were higher for individuals on a PPI (n = 6539) compared with those not on a PPI (n = 12 060) at randomization in both the clopidogrel (13.0% versus 10.9%; adjusted hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.04 -1.38) and ticagrelor (11.0% versus 9.2%; HR, 1.24; 95% CI, 1.07-1.45) groups. Patients on non-PPI gastrointestinal drugs had similar primary end point rates compared with those on a PPI (PPI versus non-PPI gastrointestinal treatment: clopidogrel, HR, 0.98; 95% CI, 0.79-1.23; ticagrelor, HR, 0.89; 95% CI, 0.73-1.10). In contrast, patients on no gastric therapy had a significantly lower primary end point rate (PPI versus no gastrointestinal treatment: clopidogrel, HR, 1.29; 95% CI, 1.12-1.49; ticagrelor, HR, 1.30; 95% CI, 1.14-1.49). Conclusions-The use of a PPI was independently associated with a higher rate of cardiovascular events in patients with acute coronary syndrome receiving clopidogrel. However, a similar association was observed between cardiovascular events and PPI use during ticagrelor treatment and with other non-PPI gastrointestinal treatment. Therefore, in the PLATO trial, the association between PPI use and adverse events may be due to confounding, with PPI use more of a marker for, than a cause of, higher rates of cardiovascular events.
Keyword
- acute coronary syndrome
- clopidogrel
- mortality
- myocardial infarction
- ticagrelor
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Goodman, Shaun G ...
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Clare, Robert
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Pieper, Karen S.
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Nicolau, Jose C.
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Storey, Robert F ...
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Cantor, Warren J ...
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show more...
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Mahaffey, Kennet ...
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Angiolillo, Domi ...
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Husted, Steen
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Cannon, Christop ...
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James, Stefan K, ...
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Kilhamn, Jan
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Steg, P. Gabriel
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Harrington, Robe ...
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Wallentin, Lars, ...
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show less...
- Articles in the publication
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Circulation
- By the university
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Uppsala University