Clopidogrel-Proton Pump Inhibitor Drug-Drug Interaction and Risk of Adverse Clinical Outcomes Among PCI-Treated ACS Patients: A Meta-analysis.
Clopidogrel-Proton Pump Inhibitor Drug-Drug Interaction and Risk of Adverse Clinical Outcomes Among PCI-Treated ACS Patients: A Meta-analysis.
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DOI：
10.18553/jmcp.2016.22.8.939
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发表时间：
2016-08
影响因子：
2.1
通讯作者：
Veenstra DL
中科院分区：
文献类型：
--
作者：
Serbin MA;Guzauskas GF;Veenstra DL
由于药物与质子泵抑制剂(PPI)的药物相互作用而导致氯吡格雷有效性减弱的不确定性导致了关于伴随治疗的指导方针的冲突。特别是，这种相互作用在接受经皮冠状动脉介入治疗(PCI)的患者中的效果还没有得到系统的评估，这是一个已知的不良心血管事件风险增加的人群。目的：综合氯吡格雷-PPI药物相互作用对冠状动脉介入治疗患者不良心血管结局影响的证据。我们进行了一项系统的文献综述，研究报告了接受了经皮冠状动脉介入治疗的患者的临床结果，并开始使用氯吡格雷，同时或不使用PPI。如果研究报告了至少一个感兴趣的临床结果(主要心血管不良事件(MACE)、心血管死亡、全因死亡、心肌梗死、中风、支架血栓形成和出血事件)，那么这些研究就包括在分析中。我们排除了非经皮冠状动脉介入治疗患者或无经皮冠状动脉介入治疗亚组分析，和/或未报告至少6个月随访的研究。统计和临床的异质性被评估，不良临床事件的危险比(HR)和95%可信区间(CI)使用德西蒙尼和莱尔德随机效应荟萃分析方法合并。我们确定了12项研究，包括50,277名符合我们的纳入和排除标准的PCI患者。我们的分析包括对随机对照试验(2例)、健康登记(3例)、索赔数据库(2例)和机构记录(5例)的回顾分析；没有确定对冠状动脉介入治疗患者的前瞻性研究。患者平均年龄在60岁左右，S，男性，有一系列的共病，包括高脂血症，糖尿病，高血压和吸烟史。介入治疗后综合MACE(HR 1.28；95%CI 1.24~1.32)、心肌梗死(HR 1.51；95%CI 1.40~1.62)和卒中(HR 1.46；95%CI 1.15~1.86)显著增加。只有一项关于胃肠道出血和合并分析的研究无法进行。统计检验表明研究之间存在异质性，但亚组分析没有揭示一个明确的来源。同时接受经皮冠状动脉介入治疗后的氯吡格雷-PPI治疗似乎与不良心血管事件显著相关。我们的研究结果表明，临床指南应警惕在这类患者群体中使用辅助治疗，还需要对个别PPI的效果进行进一步研究。
Uncertainty regarding clopidogrel effectiveness attenuation due to a drug-drug interaction with proton pump inhibitors (PPI) has led to conflicting guidelines on concomitant therapy. In particular, the effect of this interaction in patients who undergo a percutaneous coronary intervention (PCI), a population known to have increased risk of adverse cardiovascular events, has not been systematically evaluated. To synthesize the evidence of the effect of clopidogrel-PPI drug interaction on adverse cardiovascular outcomes in a PCI patient population. We conducted a systematic literature review for studies reporting clinical outcomes in patients who underwent a PCI and were initiated on clopidogrel with or without a PPI. Studies were included in the analysis if they reported at least one of the clinical outcomes of interest (major adverse cardiovascular event (MACE), cardiovascular death, all-cause death, myocardial infarction, stroke, stent thrombosis, and bleed events). We excluded studies that were not exclusive to PCI patients or had no PCI subgroup analysis, and/or did not report at least a 6-month follow up. Statistical and clinical heterogeneity were evaluated and hazard ratios (HRs) and 95% confidence intervals (CIs) for adverse clinical events were pooled using the DerSimonian and Laird random-effects meta-analysis method. We identified 12 studies comprising 50,277 PCI patients that met our inclusion and exclusion criteria. Our analysis included retrospective analyses of randomized control trials (2), health registries (3), claims databases (2), and institutional records (5); no prospective studies of PCI patients were identified. Patients were, on average, in their mid-60’s, male, and with an array of comorbidities including hyperlipidemia, diabetes, hypertension and smoking history. Concomitant therapy following PCI resulted in statistically significant increases in composite MACE (HR 1.28; 95% CI 1.24–1.32), myocardial infarction (HR 1.51; 95% CI 1.40–1.62) and stroke (HR 1.46; 95% CI 1.15–1.86). Only one study reported on GI bleed and pooled analysis couldn’t be conducted. Statistical testing suggested heterogeneity among studies, but subgroup analysis did not reveal a clear source. Concomitant clopidogrel-PPI therapy following PCI appears to be significantly associated with adverse cardiovascular events. Our findings suggest clinical guidelines should caution against the use of concomitant therapy in this patient population, and further research on the effect of individual PPIs is needed.
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影响因子：
3.5
作者：
Kwok, Chun Shing;Jeevanantham, Vinodh;Loke, Yoon Kong
通讯作者：
Loke, Yoon Kong
影响因子：
2.2
作者：
DerSimonian, Rebecca;Kacker, Raghu
通讯作者：
Kacker, Raghu
降低功能的CYP2C19基因型和氯吡格雷治疗的患者中主要患有PCI的患者的不良临床结局的风险：一项荟萃分析。
DOI：
10.1001/jama.2010.1543
发表时间：
2010-10-27
期刊：
JAMA
影响因子：
--
作者：
Mega JL;Simon T;Collet JP;Anderson JL;Antman EM;Bliden K;Cannon CP;Danchin N;Giusti B;Gurbel P;Horne BD;Hulot JS;Kastrati A;Montalescot G;Neumann FJ;Shen L;Sibbing D;Steg PG;Trenk D;Wiviott SD;Sabatine MS
通讯作者：
Sabatine MS
影响因子：
9.6
作者：
Eikelboom, John W.;Hirsh, Jack;Weitz, Jeffrey I.
通讯作者：
Weitz, Jeffrey I.
影响因子：
9.8
作者：
Abraham, Neena S.;Hlatky, Mark A.;Tomaselli, Gordon F.
通讯作者：
Tomaselli, Gordon F.