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PPI use in patients commenced on clopidogrel: a retrospective cross-sectional evaluation
journal contribution
posted on 2023-05-17, 02:49 authored by Luinstra, M, Naunton, M, Gregory PetersonGregory Peterson, Luke BereznickiLuke BereznickiBackground/Aims: Antiplatelet therapy with aspirin and clopidogrel is an important component of the management of acute coronary syndrome, but it also increases the risk of bleeding. There are no formal guidelines about the use of a proton pump inhibitor (PPI) for gastroprotection in patients on clopidogrel. This study assessed how many patients in the Royal Darwin Hospital (RDH) and the Royal Hobart Hospital (RHH) prescribed clopidogrel and at risk of bleeding were co-prescribed PPIs. Methods: We conducted a retrospective cohort study using a pharmacy database to select all patients commenced on clopidogrel in a 1-year period. We identified all patients newly prescribed clopidogrel and determined the proportion that had a risk factor for bleeding and also received a PPI. We also assessed the effect of the use of PPIs on the number of reported bleeds. Results: The final study cohort consisted of 385 patients who had been newly prescribed clopidogrel. Of all patients discharged on clopidogrel, 95·6% (368/385) had ≥1 risk factor for bleeding. One hundred and twenty-eight of these patients [128/368, (34·8%)] were discharged on a PPI. Patients on dual antiplatelet therapy with an additional risk factor for bleeding and not discharged on a PPI were more likely to develop a major bleed than patients on dual antiplatelet therapy without a risk factor for bleeding not discharged on a PPI (11·1% vs. 1·8%; P < 0·01). Patients on dual antiplatelet therapy with an additional risk factor for bleeding not discharged on a PPI had a higher probability (borderline significance) of major bleeding, compared with patients on dual antiplatelet therapy with an additional risk factor for bleeding discharged on a PPI [PPI: 1/60, (1·7%) vs. no PPI: 6/54, (11·1%); P = 0·05]. Conclusions: Our results indicate that PPIs may only lower the probability of major bleeding in patients treated with dual antiplatelet therapy, who possess additional risk factor(s) for bleeding.
History
Publication title
Journal of Clinical Pharmacy and TherapeuticsVolume
35Pagination
213-217ISSN
0269-4727Department/School
School of Pharmacy and PharmacologyPublisher
Blackwell Publishing LtdPlace of publication
9600 Garsington Rd, Oxford, England, Oxon, Ox4 2DgRights statement
The definitive published version is available online at: http://interscience.wiley.comRepository Status
- Restricted