Effect of Proton Pump Inhibitors on Clinical Outcome in Patients treated with Clopidogrel: a Meta-Analysis Bernd Jilma, Karsten Schrör, Günter Christ, Kurt Huber Medical University of Vienna, Heinrich-Heine-University, Düsseldorf, Kaiser-Franz-Joseph Hospital, Vienna, Wilhelminenhospital, Vienna Jolanta SILLER-MATULA

CONTRACEPTIVES WARFARIN CARBAMAZEPINE AMIODARON CLARITHROMYCIN SIMVASTATIN DILTIAZEM PREDNISONE METRONIDAZOLE CYTOCHROME P450 BACKGROUND

CLOPIDOGREL EFFECT SIDE EFFECT PROTON PUMP INHIBITORS (PPIs) EFFECT gastric bleeding prevention of cardiac damage prevention of gastric bleeding BACKGROUND

CLOPIDOGREL CYP450 3A4/2C19 3A5/2B6 2C9 PRODRUG ACTIVATION INACTIVATION PROTON PUMP INHIBITORS (PPIs) BACKGROUND

 25 studies reporting adjusted effect estimates  14 months follow-up  159,138 patients  34% patients on PPIs METHODS and RESULTS

MAJOR ADVERSE CARDIOVASCULAR EVENTS 29% with PPIs RR (95%CI)

MYOCARDIAL INFARCTION 31% with PPIs RR (95%CI)

GASTROINTESTINAL BLEEDING 50% with PPIs RR (95%CI)

MORTALITY no negative effect RR (95%CI)

publication type study quality study size risk to develop an event no influence on the direction of the effect influence on the magnitude of the effect SENSITIVITY ANALYSIS

SUMMARY

GASTRIC PROTECTION with PPIs unless absolutely necessary pantoprazole if indicated CONCLUSION due to no negative influence in pharmacodynamic studies