PPI co‐therapy did not adversely affect outcomes in clopidogrel users
Bibliographic record
Abstract
Using Danish population databases, Dr Schmidt and colleagues have performed a careful analysis of the possible effects of proton pump inhibitor (PPI) co-therapy among patients given clopidogrel following percutaneous coronary intervention.1 Their study is strengthened by the reliability, size and inclusiveness of these databases. Their main finding – that PPI co-therapy did not modify the protective effect of clopidogrel – is in keeping with our recent analyses of the literature.2, 3 Hopefully, their findings will go some way towards resolving the ongoing controversy about the use of PPIs by patients on clopidogrel. Although the authors claim that theirs is the first study to have examined an interaction between PPIs and clopidogrel taking into account possible discontinuation and re-commencement of treatment, others have also attempted to do this.4–6 The important study by Ray et al. found no detrimental effect of PPI co-therapy on cardiovascular outcomes and a likely beneficial influence on gastrointestinal outcomes.4 The conclusion by Schmidt et al. that PPI treatment was associated with worse cardiovascular outcomes, regardless of clopidogrel use, deserves further comment. The 95% confidence interval on their adjusted hazard ratio for long-term PPI use in clopidogrel non-users encompassed unity (0.97–1.63). It would therefore be inappropriate to conclude that PPI use was a risk factor for adverse cardiovascular outcomes. As the authors discuss, there is strong possibility of confounding; patients receiving PPIs had worse cardiovascular risk profiles than patients not given a PPI. We agree with the authors that PPI co-therapy is unlikely to adversely affect cardiovascular outcomes in patients on clopidogrel. In accordance with recent consensus-based recommendations,7 patients on clopidogrel should be given PPI co-therapy if they have additional risk factors for upper GI bleeding. Declaration of personal interests: Dr. Leontiadis has served as a consultant to AstraZeneca. Dr. Howden is a consultant to Takeda and Otsuka, and has received honoraria from Takeda, Otsuka and GlaxoSmithKline. Declaration of funding interests: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.025 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".