Outcomes Related to Concomitant Use of Clopidogrel and Proton Pump Inhibitors in CABG Patients

박영미°, 박윤희, 김재연, 송영천, 곽혜선a

서울아산병원 약제팀, 이화여자대학교 약학대학a

 Clopidogrel is the antiplatelet drug of choice for CABG patients. However, proton pump inhibitors(PPIs) decrease treatment efficacy by inhibiting CYP450 2C19, an enzyme crucial to clopidogrel activation. Our aim was to compare the outcomes of CABG surgery patients taking clopidogrel with or without a PPI. A retrospective study was conducted of patients who had undergone CABG surgery between January 1st and December 31st, 2008 at Asan Medical Center and had been prescribed clopidogrel. The outcomes were all-cause hospital revisits, ER revisits, cardiovascular(CV) related hospital revisits, and deaths occurring up to 6 months after surgery. Of 134 patients, 14.9% were prescribed PPIs and 85.1% were not. Patients who had taken clopidogre land PPIs toget her had significantly more all-cause and CV related hospital revisits than patients who had taken clopidogrel without PPIs(OR, 3.342, 95%CI, 1.06-10.54, OR, 13.63, 95%CI, 2.31-80.52, p<0.05). Our study revealed adefinite trend of increased risk in CABG surgery patients taking both clopidogrel and PPIs. Further studies are suggested with larger populations for adeeper understanding of this relationship.