Letter by Potter and Le Lorier Regarding Article, “Cardiovascular Outcomes and Mortality in Patients Using Clopidogrel With Proton Pump Inhibitors After Percutaneous Coronary Intervention or Acute Coronary Syndrome”
Bibliographic record
Abstract
To the Editor:Rassen and colleagues recently reported an analysis of a potentially clinically significant clopidogrel-proton pump inhibitor interaction among patients presenting with acute coronary syndrome or otherwise having undergone a percutaneous coronary intervention based on healthcare claims data. 1 We commend the authors of this article and the accompanying editorial 2 for their insightful treatment of this issue.Nevertheless, the following points merit further discussion.First, we were struck by the high proportion of patients who had not filled their clopidogrel prescription within 1 week of hospital discharge, approaching 70% of the overall population studied.After 3 months, only 40% of patients with a clear indication for thienopyridine therapy had filled a prescription for clopidogrel, and only 45% had done so after 6 months.It stands to reason that the clinical impact of 55% to 70% of patients not taking clopidogrel would far outweigh the modest anticipated effect of any interaction with proton pump inhibitors. 2 The reasons for such a high rate of noncompliance (or nonprescription) require elucidation because this deficit likely represents an important opportunity for targeted interventions aimed at increasing compliance with a therapy of proven benefit in both percutaneous coronary intervention and acute coronary syndrome.Second, the British Columbia subpopulation represents more than half of the total population studied.Furthermore, because the Medicare populations are limited to low-income individuals and are subject to an overrepresentation of women, it may well be that the British Columbia population better reflects the spectrum of patients receiving clopidogrel for percutaneous coronary intervention or acute coronary syndrome in current clinical practice.A significant relative risk increase (relative riskϭ1.64,95% confidence interval, 1.15 to 2.35) for revascularization after traditional adjustment for confounding (multivariate and propensity score) occurred when the Medicare patients were excluded. 1It is only after a new method of high-dimensional propensity score adjustment 3 is applied that this increased risk of revascularization disappears.As such, the authors should discuss the limitations and pitfalls of this new technique with regard to the potential for the introduction of bias and what measures were taken to ensure the validity of the final null result for revascularization in the British Columbia population.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.004 | 0.034 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.021 | 0.022 |
| Insufficient payload (model declined to judge) | 0.006 | 0.008 |
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".