Key result
Coadministering clopidogrel and PPIs suggests potential interaction but lacks RCT data to mandate practice changes.
Why the study?
Pharmacologic and clinical interactions between PPIs and clopidogrel therapies remain uncertain due to lack of adequately powered prospective randomized clinical trial data.
Does the coadministration of proton-pump inhibitors with clopidogrel reduce platelet inhibitory effects and clinical benefit in patients with cardiovascular diseases?
Does the coadministration of proton-pump inhibitors with clopidogrel reduce platelet inhibitory effects and clinical benefit in patients with cardiovascular diseases?
This review highlights the controversial interaction between clopidogrel and PPIs, noting a discrepancy between observational/pharmacodynamic data suggesting reduced clopidogrel efficacy and guideline recommendations awaiting definitive RCTs.
Current evidence does not support altering clopidogrel-PPI co-prescription; leaves open clinical relevance pending RCTs.
Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin has been successful in reducing ischemic events in a wide range of patients with cardiovascular diseases. However, the anti-ischemic effects of DAPT may also be associated with gastrointestinal (GI) complications including ulceration and bleeding particularly in 'high risk' and elderly patients. Current guidelines recommend the use of proton-pump inhibitors (PPIs) to reduce the risk of GI bleeding in patients treated with DAPT. However, pharmacodynamic studies suggest an effect of PPIs on clopidogrel metabolism with a resultant reduction in platelet inhibitory effects. Similarly, several observational studies have demonstrated reduced clopidogrel benefit in patients who coadministered PPIs. Although recent US Food and Drug Administration and European Medicines Agency statements discourage PPI (particularly omeprazole) and clopidogrel coadministration, the 2009 AHA/ACC/SCAI PCI guidelines do not support a change in current practice in the absence of adequately powered prospective randomized clinical trial data. The data regarding pharmacologic and clinical interactions between PPI and clopidogrel therapies are herein examined and treatment strategies are provided.
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Paul A. Gurbel (2010) conducted a review in Cardiovascular diseases. Clopidogrel and proton-pump inhibitors coadministration was evaluated. A review of pharmacodynamic and observational data suggests a potential interaction between clopidogrel and proton-pump inhibitors, though current guidelines do not mandate a practice change without RCT data.
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