Meta Analysis of Efficacy and Safety on Clopidogrel Combining Proton Pump Inhihibitor for Treating the Patients After Percutaneous Coronary Intervention
10.3969/j.issn.1000-3614.2014.08.006
- VernacularTitle:氯吡格雷与质子泵抑制剂联合应用于冠心病患者经皮冠状动脉介入术后安全性与疗效的Meta分析
- Author:
Jun PANG
;
Zheng ZHANG
;
Ming BAI
;
Hongling ZHANG
;
Na LI
;
Yu PENG
;
Qiang LI
;
Bo ZHANG
- Publication Type:Journal Article
- Keywords:
Clopidogrel;
Proton pump inhibitor;
Meta analysis
- From:
Chinese Circulation Journal
2014;(8):578-582
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To evaluate the efifcacy and safety on clopidogrel combining proton pump inhibitor (PPI) for treating the patient after percutaneous coronary intervention (PCI) by Meta analysis.
Methods: We searched MEDLINE, EMBASE, Cochrane Library and conference databanks, the retrieval time ended at 2014-03 and 14 references were selected for Meta analysis by RevMan 5.2 software. A total of 52274 patients were enrolled and divided into 2 groups, Control group, the patients received clopidogrel, n=43809 and Combination group, the patients received clopidogrel and PPI n=8465. The efifcacy and safety were compared between 2 groups.
Results: Compared with Control group, the patients in Combination group showed increased all cause death rate (OR=1.20, 95% CI 1.05-1.37), re-myocardial infarction (MI) (OR=1.19, 95% CI 1.07-1.33) and in-steut re-vascularization (OR=1.22, 95% CI 1.08-1.39), all P<0.05; while the MACE (OR=1.29, 95% CI 0.98-1.69), in-stent thrombosis (OR=1.22, 95% CI 0.97-1.54) and gastro- intestinal bleeding (OR=0.95, 95% CI 0.55-1.67) were similar between 2 groups, all P>0.05. Further analysis found that PPI (such as omeprazole and esomeprazole) could compete the CYP2C19 enzyme location of clopidogrel, increase the risk of cardiovascular events and decrease the gastrointestinal protection.
Conclusion: Clopidogrel combining PPI may increase the risk of all cause death, MI, in-stent revascularization and decrease the gastrointestinal protection in patients after PCI, especially for omeprazole and esomeprazole which may compete the CYP2C19 enzyme location of clopidogrel.
