Clopidogrel use and cancer-specific mortality: a population-based cohort study of colorectal, breast and prostate cancer patients

PURPOSE: Concerns were raised about the safety of antiplatelet thienopyridine derivatives after a randomized control trial reported increased risks of cancer and cancer deaths in prasugrel users. We investigate whether clopidogrel, a widely used thienopyridine derivative, was associated with increased risk of cancer-specific or all-cause mortality in cancer patients.

METHODS: Colorectal, breast and prostate cancer patients, newly diagnosed from 1998 to 2009, were identified from the National Cancer Data Repository. Cohorts were linked to the UK Clinical Practice Research Datalink, providing prescription records, and to the Office of National Statistics mortality data (up to 2012). Unadjusted and adjusted hazard ratios (HRs) for cancer-specific and all-cause mortality in post-diagnostic clopidogrel users were calculated using time-dependent Cox regression models.

RESULTS: The analysis included 10 359 colorectal, 17 889 breast and 13 155 prostate cancer patients. There was no evidence of an increase in cancer-specific mortality in clopidogrel users with colorectal (HR = 0.98 95% confidence interval (CI) 0.77, 1.24) or prostate cancer (HR = 1.03 95%CI 0.82, 1.28). There was limited evidence of an increase in breast cancer patients (HR = 1.22 95%CI 0.90, 1.65); however, this was attenuated when removing prescriptions in the year prior to death.

CONCLUSIONS: This novel study of large population-based cohorts of colorectal, breast and prostate cancer patients found no evidence of an increased risk of cancer-specific mortality among colorectal, breast and prostate cancer patients using clopidogrel.

A multi vector energy analysis for interconnected power and gas systems

This paper presents the first multi vector energy analysis for the interconnected energy systems of Great Britain (GB) and Ireland. Both systems share a common high penetration of wind power, but significantly different security of supply outlooks. Ireland is heavily dependent on gas imports from GB, giving significance to the interconnected aspect of the methodology in addition to the gas and power interactions analysed. A fully realistic unit commitment and economic dispatch model coupled to an energy flow model of the gas supply network is developed. Extreme weather events driving increased domestic gas demand and low wind power output were utilised to increase gas supply network stress. Decreased wind profiles had a larger impact on system security than high domestic gas demand. However, the GB energy system was resilient during high demand periods but gas network stress limited the ramping capability of localised generating units. Additionally, gas system entry node congestion in the Irish system was shown to deliver a 40% increase in short run costs for generators. Gas storage was shown to reduce the impact of high demand driven congestion delivering a reduction in total generation costs of 14% in the period studied and reducing electricity imports from GB, significantly contributing to security of supply.