Interaction between clopidogrel and proton-pump inhibitors and management strategies in patients with cardiovascular diseases.

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Gurbel, PA; Tantry, US; Kereiakes, DJ

Published Date

  • January 2010

Published In

Volume / Issue

  • 2 /

Start / End Page

  • 233 - 240

PubMed ID

  • 21701635

Pubmed Central ID

  • 21701635

Electronic International Standard Serial Number (EISSN)

  • 1179-1365

International Standard Serial Number (ISSN)

  • 1179-1365

Digital Object Identifier (DOI)

  • 10.2147/DHPS.S7297

Language

  • eng