Risk of Adverse Clinical Outcomes with Concomitant Use of Clopidogrel and Proton Pump Inhibitors Following Percutaneous Coronary Intervention

Abstract

Concomitant use of clopidogrel and PPI in post-PCI patients is associated with a higher risk of MACE. This suggests that PPIs may attenuate clopidogrel's beneficial antiplatelet effect, which is crucial after PCI. Prospective randomized studies are warranted to provide definitive evidence for this interaction.

Clinical Events as a Function of Proton Pump Inhibitor Use, Clopidogrel Use, and Cytochrome P450 2C19 Genotype in a Large Nationwide Cohort of Acute Myocardial Infarction

“…11,12 Although a reduction in platelet inhibition would be expected to manifest as a reduction in the clinical efficacy of clopidogrel therapy, recent clinical outcome studies have reported conflicting results. Several small studies [13][14][15] and retrospective analyses of 3 larger population-based studies 16 -18 8,19,20 In light of these conflicting results from controlled clinical trials, further large-scale investigation into the real-world efficacy of PPI and clopidogrel combination therapy is required.…”

“…26 In contrast, some previous retrospective analyses have shown an increase in cardiovascular events with coadministration of PPIs and clopidogrel. [15][16][17] These retrospective studies differ from the pivotal clinical trial analyses detailed above (TRITON-TIMI 38 and PLATO), with greater population heterogeneity, less control of assessments, and no consideration of the effects of CYP2C19 polymorphisms. The Juurlink et al 16 study was a nested, case-control study in Ontario residents Ն66 years of age.…”

“…11,12 Although a reduction in platelet inhibition would be expected to manifest as a reduction in the clinical efficacy of clopidogrel therapy, recent clinical outcome studies have reported conflicting results. Several small studies [13][14][15] and retrospective analyses of 3 larger population-based studies 16 -18 have reported an increased risk of cardiovascular events for patients receiving combined PPI and clopidogrel compared with clopidogrel alone. In contrast, results and retrospective analyses of 3 large randomized clinical trials of Ͼ41 000 clopidogrel- preliminary results]) have shown no significant effect of concomitant PPI administration on the clinical efficacy of clopidogrel therapy.…”

“…11,12 Although a reduction in platelet inhibition would be expected to manifest as a reduction in the clinical efficacy of clopidogrel therapy, recent clinical outcome studies have reported conflicting results. Several small studies [13][14][15] and retrospective analyses of 3 larger population-based studies 16 -18 8,19,20 In light of these conflicting results from controlled clinical trials, further large-scale investigation into the real-world efficacy of PPI and clopidogrel combination therapy is required.The French Registry of Acute-ST-Elevation and Non-STElevation Myocardial Infarction (FAST-MI) gathered comprehensive data on the management and outcomes of patients admitted to intensive care units with definite MIs. 21 The present analysis compared treatment outcomes in patients who did or did not receive clopidogrel and/or PPIs to assess the clinical impact of PPI treatment on the efficacy of clopidogrel therapy, with specific focus on CYP2C19 genetic polymorphisms.…”

Clinical outcomes of various continued antiplatelet therapies in patients who were administered DAPT following the implantation of drug-eluting stents and developed gastrointestinal hemorrhage

“…Yasuda et al (22) have previously demonstrated that combination therapy with DAPT and PPI decreases the effect of DAPT; however, the combination therapy was shown to decrease the risk of recurrent hemorrhage. Moreover, previous studies (23)(24)(25)(26) have also demonstrated that combination therapy with PPI and clopidogrel reduced the antiplatelet effect of clopidogrel. Therefore, whether combination therapy with clopidogrel and PPI is reasonable remains controversial, and further clinical trials are required.…”