P2447 - Cardiovascular and Bleeding Outcomes of Proton-Pump Inhibitor and Clopidogrel Co-Therapy After Percutaneous Intervention: A Meta-Analysis

Subanandhini Subramaniam, MD¹, Mobeen Haider, MBBS², Junaid Mir, MD³, Nismat Javed, MD⁴, Sahib Singh, MD⁵, Darshan Sandesara, MD⁶, Prasanna Sengodan, MD⁷, Yasar Sattar, MD², Ammad Javaid. Chaudhary, MD⁸, Muhammad Hamza, MD^9
1The Ohio State University, Columbus, OH; ²West Virginia University, Morgantown, WV; ³University of Missouri Health Care, Columbia, MO; ⁴BronxCare Health System, Bronx, NY; ⁵Sinai Hospital, Baltimore, MD; ⁶Apex Hospital, Ahmedabad, Gujarat, India; ⁷East Carolina University, Greenville, NC; ⁸Henry Ford Health, Detroit, MI; ⁹Guthrie Robert Packer Hospital, Sayre, PA

Introduction: Data regarding the concurrent use of proton pump inhibitor (PPI) with clopidogrel in patients with acute coronary syndrome (ACS) is conflicting. On one hand, there is data to support PPI and concomitant use of clopidogrel to decrease bleeding whereas, on the other hand, the concomitant use of PPIs and clopidogrel may diminish clopidogrel activity in preventing platelet aggregation by inhibiting major enzymes that activate the conversion of clopidogrel into its active metabolite. We conducted a meta-analysis evaluating the outcomes for concurrent use of these medications and comparing various PPIs in their interaction with clopidogrel.

Methods: We searched PubMed and Embase, screened 1071 articles, and included seven articles meeting our inclusion criteria: randomized control trials comparing different PPIs to control (no PPI) in patients on clopidogrel with CAD for six months. The outcomes of interest were major adverse cardiovascular events (MACE), myocardial infarction (MI), heart failure (HF), arrhythmia, bleeding, all-cause death, and cardiovascular (CV) death. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effects model. We assessed heterogeneity between studies and the p-value was assigned to < 0.05 for statistical significance. A subgroup analysis was also done comparing individual PPIs including pantoprazole and omeprazole.

Results: Seven studies with 5146 patients (PPI group: 2585, No-PPI: 2561). Our analysis shows that using PPI with clopidogrel is associated with fewer bleeding outcomes. Subgroup analysis showed that this was consistent for both pantoprazole and omeprazole compared to no PPI. Table 1. Our analysis showed no difference in all-cause mortality and cardiovascular outcomes (myocardial infarction, major cardiovascular events, onset of heart failure, arrhythmias, and cardiovascular mortality). Our subgroup analysis showed no difference in the subgroup analysis for both pantoprazole and omeprazole in all-cause mortality, and cardiovascular mortality Figure 1.

Discussion: In patients taking clopidogrel, both pantoprazole and omeprazole are associated with decreased bleeding outcomes. Our study showed no difference in terms of mortality and cardiovascular outcomes. Further randomized controlled trials are needed to validate these results.



Disclosures:


Subanandhini Subramaniam, MD¹, Mobeen Haider, MBBS², Junaid Mir, MD³, Nismat Javed, MD⁴, Sahib Singh, MD⁵, Darshan Sandesara, MD⁶, Prasanna Sengodan, MD⁷, Yasar Sattar, MD², Ammad Javaid. Chaudhary, MD⁸, Muhammad Hamza, MD⁹. P2447 - Cardiovascular and Bleeding Outcomes of Proton-Pump Inhibitor and Clopidogrel Co-Therapy After Percutaneous Intervention: A Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.