Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Impact of Concomitant Use of Proton Pump Inhibitors and Clopidogrel on Recurrent Stroke and Myocardial Infarction

Yong Kang Lee
,
Hyun Sun Lim
,
Youn I Choi
,
Eun Ju Choe
ORCID logo ,
Seonji Kim
ORCID logo ,
Seng Chan You
,
Kyung Joo Lee
,
Yerim Kim
,
Da Hee Park
,
Woon Geon Shin
ORCID logo ,
Seung In Seo
* ORCID logo
Version 1 : Received: 24 July 2023 / Approved: 24 July 2023 / Online: 25 July 2023 (07:26:31 CEST)

A peer-reviewed article of this Preprint also exists.

Lee, Y.K.; Lim, H.S.; Choi, Y.I.; Choe, E.J.; Kim, S.; You, S.C.; Lee, K.J.; Kim, Y.; Park, D.H.; Shin, W.G.; Seo, S.I. Impact of Concomitant Use of Proton Pump Inhibitors and Clopidogrel on Recurrent Stroke and Myocardial Infarction. Pharmaceuticals 2023, 16, 1213. Lee, Y.K.; Lim, H.S.; Choi, Y.I.; Choe, E.J.; Kim, S.; You, S.C.; Lee, K.J.; Kim, Y.; Park, D.H.; Shin, W.G.; Seo, S.I. Impact of Concomitant Use of Proton Pump Inhibitors and Clopidogrel on Recurrent Stroke and Myocardial Infarction. Pharmaceuticals 2023, 16, 1213.

Abstract

Background/Aims: Conflicting results have been reported regarding the interaction between proton pump inhibitors (PPIs) and clopidogrel. We investigated whether concomitant PPI use influenced the risk of recurrence in patients with stroke and myocardial infarction (MI). Methods: This study used two databases for different designs, the Korean National Health Insurance Service (NHIS) database for a self-controlled case series design, and the national sample cohort of the NHIS database converted to the Observational Medical Outcomes Partnership-Common Data Model version for a cohort study. Results: In the PPI co-prescription group, recurrent hospitalization with stroke occurred in 17.6% of the 8,201 patients with history of stroke, and recurrent MI occurred in 17.1% of the 1,216 patients with history of MI during 1 year. According to the self-controlled case series, the overall relative risk (RR) of recurrent stroke was 2.09 [95% confidence interval (CI); 1.83-2.38], and the RR showed an increasing trend with PPI duration. In the cohort study, there was a higher incidence of recurrent stroke in the PPI co-prescription group [Hazard ratio (HR): 1.34, 95% CI: 1.01-1.76, P=0.04]. The overall RR of recurrent MI was 1.47 (95% CI; 1.02-2.11) in the self-controlled case series; however, there was no statistically significant difference in recurrent MI in the cohort study (HR:1.42, 95% CI:0.79-2.49, P=0.23). The impact of individual PPIs on stroke and MI showed different patterns. Conclusions: PPI co-prescription with clopidogrel was associated with recurrent stroke; however, its association with recurrent MI remains inconclusive. The influence of individual PPIs should be clarified in the future.

Keywords

Proton pump inhibitors; Clopidogrel; Stroke; Myocardial infarction

Subject

Medicine and Pharmacology, Medicine and Pharmacology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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