The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Effect of Proton Pump Inhibitor and Clopidogrel Combination on the Outcome of Patients with Ischemic Heart Disease

허혈성 심장 환자에서 프로톤펌프억제제와 Clopidogrel 병용투여 효과

  • Kim, Won-Hee (Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Hong, Sung-Pyo (Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Kim, Yong-Hun (Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Kim, Do-Hyung (Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Chung, Jun-Gu (Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Park, Il (Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Lee, Jung-Min (Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Kwon, Chang-Il (Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Ko, Kwang-Hyun (Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Hwang, Seong-Gyu (Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Park, Pil-Won (Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Rim, Kyu-Seong (Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine)
  • 김원희 (CHA의과학대학교 분당차병원 소화기센터) ;
  • 홍성표 (CHA의과학대학교 분당차병원 소화기센터) ;
  • 김용훈 (CHA의과학대학교 분당차병원 소화기센터) ;
  • 김도형 (CHA의과학대학교 분당차병원 소화기센터) ;
  • 정준구 (CHA의과학대학교 분당차병원 소화기센터) ;
  • 박일 (CHA의과학대학교 분당차병원 소화기센터) ;
  • 이중민 (CHA의과학대학교 분당차병원 소화기센터) ;
  • 권창일 (CHA의과학대학교 분당차병원 소화기센터) ;
  • 고광현 (CHA의과학대학교 분당차병원 소화기센터) ;
  • 황성규 (CHA의과학대학교 분당차병원 소화기센터) ;
  • 박필원 (CHA의과학대학교 분당차병원 소화기센터) ;
  • 임규성 (CHA의과학대학교 분당차병원 소화기센터)
  • Published : 2011.04.01
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Abstract

Background/Aims: It has recently been suggested that proton pump inhibitors (PPIs) might reduce the inhibitory effect of clopidogrel on platelet aggregation. Co-administration of a PPI and clopidogrel in patients with ischemic heart disease may thus alter clinical outcome. We investigated the effect of concomitant use of a PPI with clopidogrel in Korean patients with ischemic heart disease. Methods: This is a retrospective cohort study of 99 patients with acute coronary syndrome taking clopidogrel and PPIs after discharge from CHA Bundang Medical Center between January 1, 2003, and December 31, 2007. The control group consisted of 99 patients who were matched for age and sex but were not taking PPIs. Results: Patients who received clopidogrel plus PPI had a greater than two times higher risk of re-admission or death (adjusted hazard ratio 2.51; 95% confidence interval [CI] 1.43~4.40; p = 0.001) than those who received clopidogrel alone. Lansoprazole use was associated with an increased risk of re-admission or death (adjusted hazard ratio 2.66; 95% CI 1.45~4.89; p = 0.002). Combined period of administration or Helicobacter pylori infection did not affect the risk of re-admission or death. Conclusions: Particular attention should be paid when patients with ischemic heart disease are prescribed a combination of clopidogrel and a PPI, since this combination was associated with an elevated risk of re-admission or death.

목적: 허혈성 심장환자에서 clopidogrel과 프로톤펌프억제제를 함께 사용하는 경우 임상적 예후에 영향을 미친다는 것이 최근 연구에서 밝혀지고 있으나 아직 국내 자료는 없는 실정이다. 이에 저자들은 국내 단일 기관을 내원한 환자를 대상으로 두 약제의 사용이 허혈성 심장환자의 임상경과에 미치는 영향을 살펴보고자 하였다. 방법: 2003년 1월부터 2007년 12월까지 협심증과 심근경색증으로 분당차병원에 내원한 환자 중 clopidogrel 투약을 시작한 환자를 대상으로 하였다. 프로톤펌프억제제를 함께 투여한 환자군을 실험군, clopidogrel만 단독으로 투여한 환자군을 대조군으로 하여 의무기록 분석을 통한 후향적 연구를 시행하였다. 결과: 흉통으로 인한 재입원이나 사망률은 실험군에서 42.4%, 대조군에서 24.2%로 유의하게 차이가 있었으며, 다변량 분석에서 프로톤펌프억제제의 병용투여는 clopidogrel을 사용하는 허혈성 심장환자에서 프로톤펌프억제제를 투여하지 않는 환자에 비해 재입원이나 사망의 위험을 높이는 것으로 나타났다(adjusted HR 2.51, 95% CI 1.43~4.40, p = 0.001). 약제 별 하위집단 분석에서는 lansoprazole의 병용투여가 그렇지 않은 환자에 비해 2.66배의 위험도를 나타내었다(adjusted HR 2.66, 95% CI 1.45~4.89, p = 0.002). 약제 사용 기간이나 용량은 재입원이나 사망의 위험도에 영향을 주지 않았다. 흉통으로 재입원 한 환자 중 재관류 요법을 다시 시행한 경우는 13.1%와 11.1%로 차이가 없었다. H. pylori의 감염 유무에 따른 primary outcome의 차이는 없었다. 결론: 허혈성 심장환자에서 재관류요법 후 clopidogrel을 투여할 때, 프로톤펌프억제제를 함께 투여하는 경우에는 흉통으로 인한 재입원이나 사망률 및 재관류요법의 시행률을 높이므로 약제의 사용에 주의를 기울여야 할 것으로 보인다.

Keywords

References

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