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

Paul A. Gurbel, Udaya S. Tantry, Dean J. Kereiakes

Research output: Contribution to journalReview article

Abstract

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.

Original languageEnglish (US)
Pages (from-to)233-240
Number of pages8
JournalDrug, Healthcare and Patient Safety
Volume2
Issue number1
DOIs
StatePublished - 2010

Keywords

  • Antiplatelet therapy
  • Cardiovascular disease
  • Gastrointestinal
  • Proton-pump inhibitor

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy

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