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BMJ 2009; 338 doi: (Published 11 March 2009) Cite this as: BMJ 2009;338:b963

Proton pump inhibitors linked to poor outcome for heart patients taking clopidogrel

A retrospective analysis of data from a large cohort of US patients suggests that men treated for acute coronary syndrome should not be given a proton pump inhibitor (PPI) routinely with their clopidogrel. Among 8205 adults (mostly men) discharged from hospital while taking clopidogrel, a proton pump inhibitor was associated with a higher risk of death or readmission to hospital during a median follow-up of 521 days (adjusted odds ratio 1.25, 95% CI 1.11 to 1.41).

The authors adjusted for dozens of potential confounders and confirmed the link between proton pump inhibitors and a worse outcome in a series of sensitivity analyses and a nested case-control study. The data aren’t perfect, but they are a red flag to doctors to be cautious with their prescribing, say the authors.

Clopidogrel and proton pump inhibitors share a common metabolic pathway, and there is good evidence that drugs such as omeprazole interfere with clopidogrel’s ability to inhibit platelet aggregation. The new findings imply, but can’t prove, that the interaction …

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