Acid suppressant use tied to risk of ischaemic events in stroke patients on clopidogrel

Acid suppressants such as potassium-competitive acid blockers (P-CABs) and proton pump inhibitors (PPIs), when used concomitantly with clopidogrel, carry an increased risk of ischaemic events in stroke patients, according to a retrospective cohort study.

Researchers used data from the Korean National Health Insurance Service database. They identified patients with incident ischaemic stroke using predefined criteria. Propensity score matching was performed to establish the following cohorts: patients receiving clopidogrel alone, those receiving clopidogrel plus P-CAB, and those receiving clopidogrel plus PPI.

The outcome of interest was 6-month incidence of major adverse cardiovascular events (MACE), including myocardial infarction, stroke recurrence, and all-cause mortality. Gastrointestinal bleeding was also assessed.

The analysis included 6,680 patients in the clopidogrel-alone cohort, 578 in the clopidogrel plus P-CAB cohort, and 8,806 in the clopidogrel plus PPI cohort. A total of 268, 26, and 431 patients in the respective cohorts experienced stroke recurrence during the follow-up.

Compared with the clopidogrel-alone cohort, the clopidogrel plus P-CAB cohort had a more than twofold higher risks of MACE (hazard ratio [HR], 2.40, 95 percent confidence interval [CI], 1.18–4.85) and stroke recurrence (HR, 2.64, 95 percent CI, 1.27–5.47).

Similarly, the clopidogrel plus PPI cohort had elevated risks of MACE (HR, 1.38, 95 percent CI, 1.17–1.63) and stroke recurrence (HR, 1.41, 95 percent CI, 1.20–1.67) relative to the clopidogrel-alone cohort. Of the PPIs, esomeprazole was associated with an increased risk of both outcomes (MACE: HR, 1.46, 95 percent CI, 1.10–1.92; stroke recurrence: HR, 1.50, 95 percent CI, 1.13–2.00).

Gastrointestinal bleeding did not differ significantly across the three cohorts.

The findings underscore the importance of cautiously prescribing P-CABs or PPIs for stroke patients on clopidogrel.