Nonsteroidal anti-inflammatory drug choice and adverse outcomes in clopidogrel users: A retrospective cohort study
Nam YH, Brensinger CM, Bilker WB, Leonard CE, Kasner SE, Grosser T, Li X, Hennessy S (2018)
PLOS ONE 13(3): e0193800.
Zeitschriftenaufsatz
| Veröffentlicht | Englisch
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Autor*in
Nam, Young Hee;
Brensinger, Colleen M.;
Bilker, Warren B.;
Leonard, Charles E.;
Kasner, Scott E.;
Grosser, TiloUniBi
;
Li, Xuanwen;
Hennessy, Sean
![](https://pub.uni-bielefeld.de/images/icon_orcid.png)
Abstract / Bemerkung
Objective
To examine the comparative safety of individual NSAIDs when given concomitantly with clopidogrel.
Methods
We conducted a retrospective cohort study using Medicaid claims from five US states during 1999–2010, supplemented with Medicare claims for dual-enrollees. The exposure of interest was the first concomitant use of clopidogrel and one of the 10 selected NSAIDs after a 1-year baseline period. The outcomes were: all-cause mortality; acute myocardial infarction (AMI)/ischemic stroke; and gastrointestinal bleeding (GIB)/intracranial hemorrhage (ICH). We calculated the hazard ratio of each NSAID for each outcome, with ibuprofen as the reference drug, using high-dimensional propensity score-adjusted proportional-hazards regression models.
Results
Of 1,060,412 clopidogrel users, 268,114 concomitant NSAID users met inclusion/exclusion criteria, contributing 48,483 person-years. We observed 2,463 deaths, 2,822 AMI/ischemic stroke outcomes, and 2,620 GIB/ICH outcomes, for unadjusted incidence rates of 50.8, 58.6, and 54.3 per 1,000 person-years, respectively. Compared with ibuprofen and controlling for potential confounders, rofecoxib (hazard ratio [HR] = 1.22; 95% confidence interval [CI]: 1.04, 1.43) and valdecoxib (HR = 0.66; 95% CI: 0.48, 0.92) showed higher and lower hazards of mortality, respectively. Indomethacin showed an increased AMI/ischemic stroke hazard (HR = 1.38; 95% CI: 1.09, 1.74). For GIB/ICH, indomethacin (HR = 2.18; 95% CI: 1.74, 2.73), diclofenac (HR = 1.65; 95% CI: 1.39, 1.97), naproxen (HR = 1.47; 95% CI: 1.28, 1.70), and rofecoxib (HR = 1.26; 95% CI: 1.08, 1.48) showed higher hazards, and valdecoxib (HR = 0.73; 95% CI: 0.55, 0.98) showed a lower hazard.
Conclusion
The bleeding risks of individual NSAIDs varied more markedly than thrombotic risks when used concomitantly with clopidogrel. Moreover, bleeding risk and thrombotic risk among individual NSAIDs did not appear to be inversely related to each other in the presence of clopidogrel. Further studies are needed to elucidate underlying biological mechanisms and help clinical decision-making for a better NSAID choice in clopidogrel users.
Erscheinungsjahr
2018
Zeitschriftentitel
PLOS ONE
Band
13
Ausgabe
3
Art.-Nr.
e0193800
Urheberrecht / Lizenzen
eISSN
1932-6203
Page URI
https://pub.uni-bielefeld.de/record/2965309
Zitieren
Nam YH, Brensinger CM, Bilker WB, et al. Nonsteroidal anti-inflammatory drug choice and adverse outcomes in clopidogrel users: A retrospective cohort study. PLOS ONE. 2018;13(3): e0193800.
Nam, Y. H., Brensinger, C. M., Bilker, W. B., Leonard, C. E., Kasner, S. E., Grosser, T., Li, X., et al. (2018). Nonsteroidal anti-inflammatory drug choice and adverse outcomes in clopidogrel users: A retrospective cohort study. PLOS ONE, 13(3), e0193800. https://doi.org/10.1371/journal.pone.0193800
Nam, Young Hee, Brensinger, Colleen M., Bilker, Warren B., Leonard, Charles E., Kasner, Scott E., Grosser, Tilo, Li, Xuanwen, and Hennessy, Sean. 2018. “Nonsteroidal anti-inflammatory drug choice and adverse outcomes in clopidogrel users: A retrospective cohort study”. PLOS ONE 13 (3): e0193800.
Nam, Y. H., Brensinger, C. M., Bilker, W. B., Leonard, C. E., Kasner, S. E., Grosser, T., Li, X., and Hennessy, S. (2018). Nonsteroidal anti-inflammatory drug choice and adverse outcomes in clopidogrel users: A retrospective cohort study. PLOS ONE 13:e0193800.
Nam, Y.H., et al., 2018. Nonsteroidal anti-inflammatory drug choice and adverse outcomes in clopidogrel users: A retrospective cohort study. PLOS ONE, 13(3): e0193800.
Y.H. Nam, et al., “Nonsteroidal anti-inflammatory drug choice and adverse outcomes in clopidogrel users: A retrospective cohort study”, PLOS ONE, vol. 13, 2018, : e0193800.
Nam, Y.H., Brensinger, C.M., Bilker, W.B., Leonard, C.E., Kasner, S.E., Grosser, T., Li, X., Hennessy, S.: Nonsteroidal anti-inflammatory drug choice and adverse outcomes in clopidogrel users: A retrospective cohort study. PLOS ONE. 13, : e0193800 (2018).
Nam, Young Hee, Brensinger, Colleen M., Bilker, Warren B., Leonard, Charles E., Kasner, Scott E., Grosser, Tilo, Li, Xuanwen, and Hennessy, Sean. “Nonsteroidal anti-inflammatory drug choice and adverse outcomes in clopidogrel users: A retrospective cohort study”. PLOS ONE 13.3 (2018): e0193800.
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