Introduction In 2009, it was announced that clopidogrel should not be taken with proton pump inhibitors. Omeprazole possibly reduces antiplatelet effect of clopidogrel. We compared mortality and cardiovascular rates between patients that had been treated with clopidogrel alone and those with both clopidogrel and omeprazole.
Methods A retrospective dynamic cohort study using secondary data of a health information system from a Health Maintenance Organization in Buenos Aires was analysed. Patients older than 17 years with purchase record of clopidogrel were followed for all-cause mortality and cardiovascular events (CE) from 1 January 2004 to 31 December 2008. Rates and 95% CIs are expressed per 1000 persons-year. Cox regression was used to obtain adjusted HRs for the risk of all-cause mortality and CE in groups exposed and unexposed concomitant to omeprazole at baseline.
Results Mean follow-up 13 months, 2518 patients received clopidogrel from whom 17.31% also received omeprazole. Exposed and unexposed to omeprazole were similar in sex (male 60%), age (mean 68) and comorbidities. The CE rate was 32.4 (95% CI 27.3 to 38.4) and 26.1 (95% CI 24.1 to 28.4) for each group respectively (RR 1.23 (p=0.026) and adjusted RR 1.15 (p=0.137)). The all-cause mortality rate was 2.5 (95% CI 1.4 to 4.5) and 1.23 (95% CI 0.8 to 1.7) for each group respectively (RR 2.06 (p=0.034) and adjusted RR 1.76 (p=0.109)).
Conclusion Patients treated with clopidogrel and omeprazole had not increase risk for all-cause mortality and for CE after adjusting for comorbidities.
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