In This Edition
Literature at a Glance: A guide to this month’s studies
- PPI use with clopidrogrel in ACS.
- Chlorhexidine sponge use reduces line infections.
- Extended thienopyridine use does not benefit DES patients.
- CABG is revascularization choice for severe CAD.
- Pre-treated CVC use reduces bloodstream infections.
- Hospitalist use grows in U.S.
- Sepsis order set improves outcomes.
- Admission day predicts acute PE mortality.
PPI Use with Clopidogrel in Acute Coronary Syndrome Is Associated with Readmissions and Mortality
Clinical question: Does concomitant use of clopidogrel and a proton pump inhibitor (PPI) following hospitalization for acute coronary syndrome (ACS) lead to adverse outcomes?
Background: Prophylactic PPIs often are prescribed with clopidogrel to reduce the risk of gastrointestinal bleeding. Mechanistic studies have shown that omeprazole decreases the platelet-inhibitory effect of clopidogrel, raising concerns that PPIs might interfere with clopidogrel’s beneficial effects. The clinical significance of this finding is unknown.
Study design: Retrospective cohort study.
Setting: 127 VA hospitals.
Synopsis: Investigators used data from the Cardiac Care Follow-up Clinical Study and VA pharmacy records to examine 8,205 male veterans who were hospitalized for ACS and treated with clopidogrel. Patients who filled prescriptions for both clopidogrel and a PPI were at significantly higher risk for death or readmission with ACS compared with those who filled prescriptions for clopidogrel only (adjusted odds ratio, 1.25; 95% confidence interval, 1.11-1.41). Patients who filled prescriptions for PPIs alone had similar risk for adverse events as those who took neither medication.
Subanalyses found similarly increased risk among patients prescribed omeprazole and rabeprazole, but those taking lanzoprazole and pantoprazole were not examined due to the small sample size. Although causality cannot be inferred from this observational study, and the risk associated with combined clopidigrel and PPI use appeared small, alternatives for gastric acid reduction exist. Thus, it may be prudent to restrict PPI use to patients who have a clear indication for their use until more definitive clinical trials can be conducted.