Comparative risk of ischemic stroke among users of clopidogrel together with individual proton pump inhibitors

Charles E. Leonard, Warren B. Bilker, Colleen M. Brensinger, David A. Flockhart, Cristin P. Freeman, Scott E. Kasner, Stephen E. Kimmel, Sean Hennessy

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background and Purpose: There is controversy and little information about whether individual proton pump inhibitors (PPIs) differentially alter the effectiveness of clopidogrel in reducing ischemic stroke risk. We, therefore, aimed to elucidate the risk of ischemic stroke among concomitant users of clopidogrel and individual PPIs. Methods: We conducted a propensity score-adjusted cohort study of adult new users of clopidogrel, using 1999 to 2009 Medicaid claims from 5 large states. Exposures were defined by prescriptions for esomeprazole, lansoprazole, omeprazole, rabeprazole, and pantoprazole-with pantoprazole serving as the referent. The end point was hospitalization for acute ischemic stroke, defined by International Classification of Diseases Ninth Revision Clinical Modification codes in the principal position on inpatient claims, within 180 days of concomitant therapy initiation. Results: Among 325 559 concomitant users of clopidogrel and a PPI, we identified 1667 ischemic strokes for an annual incidence of 2.4% (95% confidence interval, 2.3-2.5). Adjusted hazard ratios for ischemic stroke versus pantoprazole were 0.98 (0.82-1.17) for esomeprazole; 1.06 (0.92-1.21) for lansoprazole; 0.98 (0.85-1.15) for omeprazole; and 0.85 (0.63-1.13) for rabeprazole. Conclusions: PPIs of interest did not increase the rate of ischemic stroke among clopidogrel users when compared with pantoprazole, a PPI thought to be devoid of the potential to interact with clopidogrel.

Original languageEnglish (US)
Pages (from-to)722-731
Number of pages10
JournalStroke
Volume46
Issue number3
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

Fingerprint

clopidogrel
Proton Pump Inhibitors
Stroke
Rabeprazole
Esomeprazole
Lansoprazole
Omeprazole
Propensity Score
Medicaid
International Classification of Diseases
Prescriptions
Inpatients
Hospitalization
Cohort Studies
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Leonard, C. E., Bilker, W. B., Brensinger, C. M., Flockhart, D. A., Freeman, C. P., Kasner, S. E., ... Hennessy, S. (2015). Comparative risk of ischemic stroke among users of clopidogrel together with individual proton pump inhibitors. Stroke, 46(3), 722-731. https://doi.org/10.1161/STROKEAHA.114.006866

Comparative risk of ischemic stroke among users of clopidogrel together with individual proton pump inhibitors. / Leonard, Charles E.; Bilker, Warren B.; Brensinger, Colleen M.; Flockhart, David A.; Freeman, Cristin P.; Kasner, Scott E.; Kimmel, Stephen E.; Hennessy, Sean.

In: Stroke, Vol. 46, No. 3, 01.03.2015, p. 722-731.

Research output: Contribution to journalArticle

Leonard, CE, Bilker, WB, Brensinger, CM, Flockhart, DA, Freeman, CP, Kasner, SE, Kimmel, SE & Hennessy, S 2015, 'Comparative risk of ischemic stroke among users of clopidogrel together with individual proton pump inhibitors', Stroke, vol. 46, no. 3, pp. 722-731. https://doi.org/10.1161/STROKEAHA.114.006866
Leonard CE, Bilker WB, Brensinger CM, Flockhart DA, Freeman CP, Kasner SE et al. Comparative risk of ischemic stroke among users of clopidogrel together with individual proton pump inhibitors. Stroke. 2015 Mar 1;46(3):722-731. https://doi.org/10.1161/STROKEAHA.114.006866
Leonard, Charles E. ; Bilker, Warren B. ; Brensinger, Colleen M. ; Flockhart, David A. ; Freeman, Cristin P. ; Kasner, Scott E. ; Kimmel, Stephen E. ; Hennessy, Sean. / Comparative risk of ischemic stroke among users of clopidogrel together with individual proton pump inhibitors. In: Stroke. 2015 ; Vol. 46, No. 3. pp. 722-731.
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