caa a22 4500 445887753 CHVBK 20180317145604.0 cr unu---uuuuu 170323e20110101xx s 000 0 eng 10.1007/s00535-010-0299-0 doi (NATIONALLICENCE)springer-10.1007/s00535-010-0299-0 Cardiovascular and gastrointestinal events of three antiplatelet therapies: clopidogrel, clopidogrel plus proton-pump inhibitors, and aspirin plus proton-pump inhibitors in patients with previous gastrointestinal bleeding [Elektronische Daten] [Yi-Wen Tsai, Yu-Wen Wen, Weng-Foung Huang, Pei-Fen Chen, Ken Kuo, Fei-Yuan Hsiao] Background: Concomitant use of antiplatelet agents and proton-pump inhibitors (PPIs) has been recommended in patients with a history of gastrointestinal (GI) hemorrhage. However, recent studies have reported that PPIs may alter clopidogrel's pharmacokinetics and potentially lead to an increased risk of recurrent adverse cardiovascular (CV) events. Methods: Using Taiwan's 2000-2006 National Health Insurance database, this population-based retrospective cohort study assessed CV and GI events in patients who had a prior history of GI bleeding and had been prescribed ongoing antiplatelet therapy after acute coronary syndrome (ACS) discharge. We identified 3,580 ACS patients and categorized them into (1) those taking clopidogrel alone, (2) those taking clopidogrel plus PPIs, and (3) those taking aspirin plus PPIs. Cox proportional hazards models were used to assess the association between the use of antiplatelet therapies and CV/GI events. Results: The clopidogrel only group and the clopidogrel plus PPI group were found to be at lower risk for GI events than the aspirin plus PPI group [adjusted hazard ratio (HR) 0.23 (95% confidence interval; CI 0.14-0.36) and HR 0.70 (0.52-0.96), respectively]. However, while the clopidogrel only group had a lower risk of CV events than the aspirin plus PPI group [HR 0.57 (0.38-0.84)], the clopidogrel plus PPI group had a significantly higher CV risk than the aspirin plus PPI group [HR 1.59 (1.18-2.13)]. Conclusions: Our findings suggest that although the use of clopidogrel plus PPIs provides GI benefits, with this treatment, there is an increased CV risk among patients with a history of GI bleeding. Springer, 2010 Clopidogrel nationallicence Proton-pump inhibitors (PPIs) nationallicence Cardiovascular events nationallicence Gastrointestinal bleeding nationallicence Tsai Yi-Wen Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan aut Wen Yu-Wen Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Tao-Yuan, Taiwan aut Huang Weng-Foung Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan aut Chen Pei-Fen Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Miaoli, Taiwan aut Kuo Ken Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan aut Hsiao Fei-Yuan Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, 21201, Baltimore, MD, USA aut Journal of Gastroenterology Springer Japan 46/1(2011-01-01), 39-45 0944-1174 46:1<39 2011 46 535 https://doi.org/10.1007/s00535-010-0299-0 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00535-010-0299-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Tsai Yi-Wen Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan aut NATIONALLICENCE 700 1- Wen Yu-Wen Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Tao-Yuan, Taiwan aut NATIONALLICENCE 700 1- Huang Weng-Foung Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan aut NATIONALLICENCE 700 1- Chen Pei-Fen Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Miaoli, Taiwan aut NATIONALLICENCE 700 1- Kuo Ken Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan aut NATIONALLICENCE 700 1- Hsiao Fei-Yuan Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, 21201, Baltimore, MD, USA aut NATIONALLICENCE 773 0- Journal of Gastroenterology Springer Japan 46/1(2011-01-01), 39-45 0944-1174 46:1<39 2011 46 535 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer