Abstract
BACKGROUND: Recent studies suggest a higher risk of adverse cardiovascular outcome and mortality in patients co-prescribed clopidogrel with proton pump inhibitors (PPI). OBJECTIVE: Investigate the impact of concomitant prescription of clopidogrel and PPI on 30-day unplanned readmission and one-year all-cause mortality. DESIGN: Retrospective longitudinal cohort study. SETTING: Single academic tertiary center. PATIENTS AND METHODS: The study included patients admitted with a diagnosis of ischemic or hemorrhagic stroke between 2010 and 2014. Demographic and outcome data were collected and compared for patients on clopidogrel plus PPI vs those on clopidogrel plus H2blockers and those not on clopidogrel. MAIN OUTCOME MEASURES: One-year mortality and 30-day unplanned readmissions were compared among different patient groups using multivariable logistic regression modeling. SAMPLE SIZE: 464 patients. RESULTS: Out of 464 patients, 175 (37.7%) were discharged on clopidogrel. The concomitant prescription of clopidogrel and PPI was noted in 107 (24.4%) and clopidogrel and H2 blockers in 36 patients (7.8%). The one-year all-cause mortality in the entire cohort was 22.2%. Patients on clopidogrel plus PPI did not have a higher risk of one-year mortality compared to the non-PPI cohort (6.2% vs. 4.8%, p 0.7). There was a non-significant suggestion of lower one-year mortality in patients on clopidogrel plus PPI vs those not on clopidogrel (6.2% vs. 10.1%, p 0.23). In multivariable logistic regression, the use of clopidogrel plus PPI did not predict higher one-year mortality (odds ratio 0.6, P=0.6). The risk of unplanned 30-day readmission was lower in those with clop-idogrel plus PPI (odds ratio 0.6, P=.03). CONCLUSION: The use of clopidogrel plus PPI resulted in lower readmission rates and was not associated with higher mortality compared with the non-PPI cohorts. LIMITATIONS: Single center study, not generalizable. Given the retrospective nature of this study, we did not collect data on duration of treatments or patient compliance. CONFLICT OF INTEREST: None.