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PPI use in patients commenced on clopidogrel: A retrospective cross-sectional evaluation

Luinstra, M., Naunton, Mark, Peterson, G.M. and Bereznicki, L. (2010). PPI use in patients commenced on clopidogrel: A retrospective cross-sectional evaluation. Journal of Clinical Pharmacy and Therapeutics,35(2):213-217.

Document type: Journal Article
Citation counts: Scopus Citation Count Cited 12 times in Scopus Article | Citations

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Title PPI use in patients commenced on clopidogrel: A retrospective cross-sectional evaluation
Author Luinstra, M.
Naunton, Mark
Peterson, G.M.
Bereznicki, L.
Journal Name Journal of Clinical Pharmacy and Therapeutics
Publication Date 2010
Volume Number 35
Issue Number 2
ISSN 0269-4727   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-77749279855
Start Page 213
End Page 217
Total Pages 5
Place of Publication United Kingdom
Publisher Wiley-Blackwell Publishing Ltd.
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 ≥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.
Keywords Aspirin
Bleeding
Clopidogrel
PPI
DOI http://dx.doi.org/10.1111/j.1365-2710.2009.01089.x   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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Created: Fri, 29 Aug 2014, 17:37:38 CST by Anthony Hornby