ผลลัพธ์ทางคลินิกของผู้ป่วยไทยกลุ่มอาการหลอดเลือดหัวใจตีบเฉียบพลันที่ได้รับยาโคลพิโดเกรลร่วมกับยาโอเมพราโซล

Abstract

The prevalence of CYP2C19 poor metabolizer in Thais is much greater than among other populations in previous study that may result in clinical significance of drug interactions between clopidogrel and omeprazole. In Thai patients, there was still lack of information regarding the interaction between these two drugs. The objective of this study was to compare clinical outcomes of Thai patients with acute coronary syndrome (ACS) receiving clopidogrel concomitant with omeprazole and without omeprazole. Analytical retrospective cohort study consisting of 839 patients with ACS taking clopidogrel after discharge between January 1, 2006 and December 31, 2010 from Maharaj Nakorn Chiangmai Hospital was carried out. The primary outcome was the combined end point of all-cause mortality or rehospitalization for revascularization. Among 839 patients, 46.0% (n=386) received clopidogrel with omeprazole and 54.0 % (n=453) did not received omeprazole. Univariable logistic regression analysis showed that the patients receiving omeprazole had similar incidence rate of combined all-cause mortality or rehospitalization for revascularization compared to those without omeprazole use (22.5% and 26.0 %, respectively, p=0.963) and there were comparable of secondary outcomes, all-cause mortality (p-value = 0.950) and rehospitalization for revascularization (p-value = 0.206) between the patients with concomitant use of omeprazole and those without omeprazole. From multivariable cox-proportional hazard analyses, receiving omeprazole was not associated with an increased risk of all-cause mortality or rehospitalization for revascularization (adjusted hazard ratio 1.00; 95%CI, 0.75-1.32). Additionally, Kaplan-Meier curves analysis showed that time to events of all-cause mortality or rehospitalization for revascularization in both groups were comparable, there is statistically significant difference (log rank test, p-value = 0.919). The results of this study suggest that Thai patients with ACS receiving clopidogrel concomitant with omeprazole.were not associated with increased rate of adverse cardiovascular events.