PPI use in patients commenced on clopidogrel

a retrospective cross-sectional evaluation

M Luinstra, M Naunton, G M Peterson, L Bereznicki

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

BACKGROUND/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 >or=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.

Original languageEnglish
Pages (from-to)213-7
Number of pages5
JournalJournal of Clinical Pharmacy and Therapeutics
Volume35
Issue number2
DOIs
Publication statusPublished - Apr 2010

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clopidogrel
Proton Pump Inhibitors
Hemorrhage
Cohort Studies
Therapeutics

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title = "PPI use in patients commenced on clopidogrel: a retrospective cross-sectional evaluation",
abstract = "BACKGROUND/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 >or=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.",
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PPI use in patients commenced on clopidogrel : a retrospective cross-sectional evaluation. / Luinstra, M; Naunton, M; Peterson, G M; Bereznicki, L.

In: Journal of Clinical Pharmacy and Therapeutics, Vol. 35, No. 2, 04.2010, p. 213-7.

Research output: Contribution to journalArticle

TY - JOUR

T1 - PPI use in patients commenced on clopidogrel

T2 - a retrospective cross-sectional evaluation

AU - Luinstra, M

AU - Naunton, M

AU - Peterson, G M

AU - Bereznicki, L

PY - 2010/4

Y1 - 2010/4

N2 - BACKGROUND/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 >or=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.

AB - BACKGROUND/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 >or=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.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Aspirin

KW - Cohort Studies

KW - Cross-Sectional Studies

KW - Drug Therapy, Combination

KW - Female

KW - Gastrointestinal Hemorrhage

KW - Humans

KW - Male

KW - Middle Aged

KW - Northern Territory

KW - Platelet Aggregation Inhibitors

KW - Proton Pump Inhibitors

KW - Retrospective Studies

KW - Risk Factors

KW - Tasmania

KW - Ticlopidine

KW - Young Adult

KW - Journal Article

U2 - 10.1111/j.1365-2710.2009.01089.x

DO - 10.1111/j.1365-2710.2009.01089.x

M3 - Article

VL - 35

SP - 213

EP - 217

JO - Journal of Clinical and Hospital Pharmacy

JF - Journal of Clinical and Hospital Pharmacy

SN - 0269-4727

IS - 2

ER -