{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T15:20:43Z","timestamp":1774279243447,"version":"3.50.1"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T00:00:00Z","timestamp":1625788800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T00:00:00Z","timestamp":1625788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["2019-00209"],"award-info":[{"award-number":["2019-00209"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Drugs Ther"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Due to shared hepatic metabolism, concomitant medication with a proton pump inhibitor (PPI) and clopidogrel might reduce the effectiveness of clopidogrel in the prevention of cardiovascular events after percutaneous coronary intervention (PCI). We aimed to examine the risk of major cardiovascular events after PCI comparing patients who used clopidogrel together with PPI with those who used clopidogrel alone.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This Swedish nationwide cohort study included patients who received clopidogrel after primary PCI in 2005\u20132019. Patients were followed for up to 12\u00a0months after PCI. Data were retrieved from the Swedish Prescribed Drug Registry, Patient Registry, Cancer Registry, and Cause of Death Registry. Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs) for cardiovascular events comparing PPI users (exposed) with non-users of PPI (non-exposed). The HRs were adjusted for sex, age, comorbidity, calendar period, obesity, diabetes, anti-diabetic medication, tobacco-related diseases, hypertension, and congestive heart failure.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The cohort included 99,836 patients who received clopidogrel after primary PCI. Among these, 35,772 (35.8%) received concomitant PPI. Compared to non-users, PPI users had increased adjusted HRs of all study outcomes, i.e., the main outcome myocardial infarction (HR\u2009=\u20091.23, 95% CI 1.15\u20131.32) and the secondary outcomes coronary heart disease (HR\u2009=\u20091.28, 95% CI 1.24\u20131.33), stroke (HR\u2009=\u20091.21, 95% CI 1.05\u20131.40), and death due to coronary heart disease (HR\u2009=\u20091.52, 95% CI 1.37\u20131.69). The results were similar in analyses including both primary and secondary PCIs.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>In patients who receive clopidogrel after PCI, concomitant use of PPI seems to increase the risk of major cardiovascular events.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s10557-021-07219-6","type":"journal-article","created":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T04:03:13Z","timestamp":1625803393000},"page":"1121-1128","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Proton Pump Inhibitor and Clopidogrel Use After Percutaneous Coronary Intervention and Risk of Major Cardiovascular Events"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3760-5906","authenticated-orcid":false,"given":"John","family":"Maret-Ouda","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giola","family":"Santoni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaohua","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annika","family":"Rosengren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesper","family":"Lagergren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,7,9]]},"reference":[{"issue":"4","key":"7219_CR1","doi-asserted-by":"publisher","first-page":"e362","DOI":"10.1161\/CIR.0b013e3182742c84","volume":"127","author":"PT O\u2019Gara","year":"2013","unstructured":"O\u2019Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF\/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362-425.","journal-title":"Circulation"},{"issue":"2","key":"7219_CR2","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","volume":"39","author":"B Ibanez","year":"2018","unstructured":"Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119\u201377.","journal-title":"Eur Heart J"},{"key":"7219_CR3","doi-asserted-by":"publisher","first-page":"1550","DOI":"10.3389\/fphys.2018.01550","volume":"9","author":"A Demcsak","year":"2018","unstructured":"Demcsak A, Lantos T, Balint ER, Hartmann P, Vincze A, Bajor J, et al. PPIs are not responsible for elevating cardiovascular risk in patients on clopidogrel-A systematic review and meta-analysis. Front Physiol. 2018;9:1550.","journal-title":"Front Physiol"},{"issue":"5","key":"7219_CR4","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1161\/CIRCULATIONAHA.110.965640","volume":"123","author":"T Simon","year":"2011","unstructured":"Simon T, Steg PG, Gilard M, Blanchard D, Bonello L, Hanssen M, et al. Clinical events as a function of proton pump inhibitor use, clopidogrel use, and cytochrome P450 2C19 genotype in a large nationwide cohort of acute myocardial infarction: results from the French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI) registry. Circulation. 2011;123(5):474\u201382.","journal-title":"Circulation"},{"issue":"6","key":"7219_CR5","doi-asserted-by":"publisher","first-page":"378","DOI":"10.7326\/0003-4819-153-6-201009210-00005","volume":"153","author":"M Charlot","year":"2010","unstructured":"Charlot M, Ahlehoff O, Norgaard ML, Jorgensen CH, Sorensen R, Abildstrom SZ, et al. Proton-pump inhibitors are associated with increased cardiovascular risk independent of clopidogrel use: a nationwide cohort study. Ann Intern Med. 2010;153(6):378\u201386.","journal-title":"Ann Intern Med"},{"issue":"1","key":"7219_CR6","doi-asserted-by":"publisher","first-page":"e023155","DOI":"10.1136\/bmjopen-2018-023155","volume":"9","author":"SH Xie","year":"2019","unstructured":"Xie SH, Santoni G, Mattsson F, Ness-Jensen E, Lagergren J. Cohort profile: the Swedish Prescribed Drugs and Health Cohort (SPREDH). 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The study was registry based and did not include human participants or animals. Informed consent is not required in this type of study in Sweden.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}}]}}