Using PPIs with Clopidogrel Associated with Adverse Outcomes After ACS

04 mar 2009--After acute coronary syndrome, use of a proton pump inhibitor (PPI) alongside clopidogrel is associated with more frequent rehospitalization or mortality compared with clopidogrel alone, according to an observational study in JAMA.

Veterans Affairs researchers examined outcomes in some 8200 patients prescribed clopidogrel at discharge after ACS. Nearly two thirds of the patients also received a PPI either at discharge or during a median 1.5-year follow-up. The primary endpoint, a combination of rehospitalization for ACS or death from any cause, occurred more often among those taking clopidogrel with a PPI than among those taking clopidogrel alone.

The authors note that previous studies have shown that PPIs attenuate clopidogrel's antiplatelet effects.

In Journal Watch Cardiology, JoAnne Foody concludes: "Although [the current] results bear the limitations of all observational studies ... clinicians should consider this potential interaction when they weigh the pros and cons of prescribing a PPI with clopidogrel for ACS patients."

LINK(S):

JAMA article (Free)