Editorials

Prescribing proton pump inhibitors with clopidogrel

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e4558 (Published 10 July 2012) Cite this as: BMJ 2012;345:e4558
  1. Laura Ellyn Targownik, associate professor of medicine, section of gastroenterology
  1. 1Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada, R3N 0V6
  1. targowni{at}cc.umanitoba.ca

Stronger evidence emerges that PPIs do not cause myocardial infarction in users of dual antiplatelet treatment

In a linked research paper (doi:10.1136/bmj.e4388), Douglas and colleagues analysed whether proton pump inhibitors (PPIs) influence the risk of adverse cardiovascular outcomes in users of aspirin and clopidogrel.1 The use of aspirin and clopidogrel, or dual antiplatelet treatment, is currently the standard of care for the prevention of coronary stent thrombosis.2 These drugs are also used in the management of other cardiovascular conditions.3 Although use of dual antiplatelet therapy is associated with an increased risk of gastrointestinal haemorrhage,4 this risk can be greatly reduced through the concomitant use of a PPI.5 However, clinicians have become worried about using PPIs with dual antiplatelet treatment after the discovery that PPIs may interfere with clopidogrel mediated platelet inhibition through inhibition of the CYP2C19 cytochrome pathway, which is necessary for activation of clopidogrel.6 In addition, the findings of observational studies suggest that PPIs are associated with an increased risk of adverse cardiac outcomes in users of dual antiplatelet treatment.7 However, given the inherent biases in observational datasets, it is unclear whether this …

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