Effects of Clopidogrel and Proton Pump Inhibitors on Cardiovascular Events in Patients with Type 2 Diabetes Mellitus after Bare Metal Stent Implantation: A Nationwide Cohort Study
Background: Clopidogrel (CLO) is an anti-platelet agent for prevention cardiovascular (CV) events after coronary stent implantation. Proton pump inhibitors (PPIs) are used to reduce risk of gastrointestinal bleeding. Some studied showed PPIs may interfere with the activation of CLO and attenuate its effect. To investigate whether there is an increased risk of cardiac events in diabetic patients with a combined therapy of CLO and PPIs after bare metal stent (BMS) deployment.
Methods: Using the National Health Insurance Research Database (NHIRD), all patients undergoing deployment of BMS received a therapy of CLO with/without PPIs for 90 days. The end points were acute coronary syndrome (ACS) and re-admission for revascularization (percutaneous coronary intervention or coronary artery bypass graft surgery) after 3, 6, and 12 months.
Results: There were 6,757 patients with diabetes who received BMS (6,243 in the CLO subgroup and 514 in the CLO plus PPIs subgroup). The patients who received CLO plus PPIs showed no increase in adverse CV events compared with those who received CLO within one year after BMS deployment (3-month hazard ratio (HR) = 0.87, 95% confidence interval (CI), 0.65-1.15, 6 months HR = 0.95, 95% CI, 0.78-1.15, 1 year HR = 0.60, 95% CI, 0.81-1.12).
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