Combining PPIs, thienopyridines raises stroke risk

  • Stroke.

  • Susan London
  • Clinical Essentials
L'accesso ai contenuti di questo sito è riservato agli operatori del settore sanitario italiano L'accesso ai contenuti di questo sito è riservato agli operatori del settore sanitario italiano

Takeaway

  • Adjusted risk for stroke was nearly one-third higher when a proton pump inhibitor (PPI) was added to a thienopyridine.

Why this matters

  • PPIs are often used as gastroprotective agents in patients taking thienopyridines.
  • Most studies looking at this drug interaction have focused on cardiovascular outcomes.

Key results

  • Compared with use of thienopyridine alone, concomitant use of PPI and thienopyridines increased unadjusted risk for ischemic stroke (RR, 1.74; P<.001 the composite of stroke myocardial infarction or cardiovascular death p=".04);" and>
  • In adjusted analyses, concomitant use increased risk for any stroke (aHR, 1.30; P=.02) and the composite of stroke, myocardial infarction, or cardiovascular death (aHR, 1.23; P=.02), but risk for myocardial infarction was no longer significantly elevated (aHR, 1.19; P=.16).
  • The combination did not significantly increase risks for bleeding (major or minor), cardiovascular death, or all-cause mortality.

Study design

  • A systematic review and meta-analysis of 22 studies (12 randomized controlled trials, 10 cohort studies) among 131,714 patients.
  • Main outcomes: cerebrovascular outcomes.
  • Funding: None.

Limitations

  • Majority of patients had experienced acute coronary syndromes.
  • Definitions of endpoints were often unclear.
  • Most randomized trial analyses were post hoc.
  • Populations and follow-up differed.
  • Evaluation of publication bias was limited.