Response to clopidogrel with proton pump inhibitors: safe or not?

The authors conducted literature research on bothprospective and retrospective data and concluded thatthere is little evidence to suggest an interaction betweenclopidogrel and proton pump inhibitors (PPIs). We wish toshare the findings at our unit.We undertook an observational retrospective study of188 consecutive patients (122 non–ST-segment elevationmyocardial infarction, 66 ST-segment elevation myocardialinfarction) treated with dual antiplatelet therapy (DAT)following acute coronary syndrome (ACS) over a period of1 year.Patientsweredividedin2groups:PPIgroup(patientsonDATandPPI,n=96)andcontrolgroup(patientsonDATonly, n=88). The end point was recurrence of ACS or death12 months after the index coronary event.Clopidogrel and aspirin were discontinued in 4 patientsdue to gastrointestinal bleeding, and these patients weretherefore excluded from the study. Data were analyzedin 184 patients. There were 66% males and 34% females;73% were Caucasian and 27% Asian. The mean age ofthe patients was 67 years (range, 24–96 years). In the PPIgroup, 10 patients (10/96, 10.4%) were readmitted withfurther myocardial infarction (6 on lansoprazole and 4 onpantoprazole). In the control group, 2 patients (2/88, 2.3%)were readmitted with a further myocardial infarction. Usingthe test of independent proportion, this difference in the rateof recurrence of coronary event was statistically significant(