Why the study?
Does concomitant PPI use with clopidogrel affect the risk of upper gastrointestinal bleeding and cardiovascular outcomes in patients with previous cerebrovascular events, ACS, or PCI?
Does concomitant PPI use with clopidogrel affect the risk of upper gastrointestinal bleeding and cardiovascular outcomes in patients with previous cerebrovascular events, ACS, or PCI?
Concomitant use of PPIs with clopidogrel may attenuate its antiplatelet effect via CYP2C19 interaction, potentially worsening cardiovascular outcomes.
May warrant PPI alternatives with clopidogrel; leaves open confirmation of worsened outcomes in prospective trials.
Clopidogrel is an antiplatelet drug that is used in patients who have had previous cerebrovascular events, acute coronary syndromes, or percutaneous coronary interventions (PCI). Clopidogrel therapy is associated with bleeding complications, and gastrointestinal bleeding has been reported as one of the most common life-threatening complications. This review focuses on the possible interaction between clopidogrel and CYP2C19, a known site of PPI metabolism. This interaction attenuates the antiplatelet effect of clopidogrel and seems to worsen cardiovascular outcome. Alternative concomitant therapy is also discussed.
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Hiroshi Yasuda (2011) studied this question.
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