W1109 Mosapride as Adjunct to Lansoprazole for Symptom Relief of Reflux Esophagitis: Double-Blind Randomized Trial

Background: Clopidogrel is a prodrug requiring a cytochrome (CYP)2C19-dependent conversion to become active. Usage of proton pump inhibitors (PPIs) might attenuate clopidogrel's platelet inhibitory effect. Methods: We performed a meta-analysis of studies in Pubmed, Ovid, ISI Science, and Embase. Primary analysis was based on definite outcomes including all cause mortality, cardiac death, myocardial infarction, and/or stroke. Secondary analysis also incorporated probable cardiac events which included re-hospitalization for cardiac symptoms or revascularization procedures. Odds ratios were obtained for studies with definite and probable endpoints and were combined using a random-effects model. Risk difference (RD) was defined as the difference in disease/event rate between the control and treatment. Results: We reviewed 898 publications and found 8 relevant studies: 2 were excluded due to data quality and 1 was excluded because controls used PPIs. 5 studies were analyzed, including 2 published articles and 3 abstracts. 2 meta-analysis were conducted: the first considered only the published articles and the second considered all 5 studies. (Figure) Usage of clopidogrel + PPI was associated with a small non-significant increase in definite events (Risk Difference (RD) 0.0083, 95% CI -0.00022 to 1.2). When probable events were included, the risk difference was significant (RD 0.066, 95% CI 0.055 to 0.077). There was evidence of heterogeneity (p=0.028) between studies. Conclusions: This metaanalysis does not support an adverse relationship between clopidogrel and PPIs when the primary focus was death or definite cardiovascular events.