The influence of proton pump inhibitors on the effect of clopidogrel on the risk of recurrent ischemic stroke
Abstract: Patients surviving
with a stroke have an increased risk for recurrent stroke. Clopidogrel is widely
used to prevent recurrent stroke. However, clopidogrel may cause
gastrointestinal bleeding (GIB). Therefore, proton pump inhibitors (PPIs) is
recommended to reduce the side effect of clopidogrel. Unfortunately, these both
drugs are metabolized in the liver by the same enzyme i.e. cytochrome P4502C19
(CYP219) that may reduce the effect of clopidogrel. The aim of this study was
to evaluate the influence of PPIs on the effect of clopidogrel in the
prevention of recurrent stroke. It was a hospital-based case control study
conducted in Bethesda Private Hospital, Yogyakarta involving 392 patients with recurrent
stroke as cases and 784 patients with first-ever stroke as controls. The
exposure of PPIs during clopidogrel therapy on both cases and controls groups
were recorded from prescription records for at least six months before index
date. The duration of PPIs exposure were categorized as current expoure (less
than two months before the index date) and recent exposure (2-6 months before
the index date). The result showed there was no influence of PPIs exposure on
the effect of clopidogrel on the risk of recurrent ischemic stroke (OR: 1.00;
95% CI: 0.56-1.79). Moreover, the current use of PPIs and clopidogrel could
decrease the risk of recurrent ischemic stroke (OR: 0.04; 95% CI: 0.01-0.41).
In conclusion, there is no association between PPI exposure and the risk of recurrent
stroke in patients receiving clopidogrel.
Author: Endang Mahati, Jarir
Atthobari, Ngatidjan
Journal Code: jpkedokterangg150359