Concomitant Use of Clopidogrel and Proton-Pump Inhibitor
There are emerging reports supporting the fact that proton-pump inhibitors competitively inhibit the metabolism of clopidogrel to its active metabolite and diminish its clinical efficacy, especially in patients on long-term dual antiplatelet therapy. In this article, we examine the current evidence and provide interpretation of the results along with practical recommendations for healthcare providers.
Consensus guidelines from the American College of Gastroenterology, the American College of Cardiology and the American Heart Association endorse the use of proton-pump inhibitor(s) (PPI) in patients judged to be at higher risk for gastrointestinal (GI) ulceration and related complications. This recommendation is largely based on an observational study reporting PPI cotherapy to be beneficial in reducing the risk of upper GI bleed in patients on clopidogrel monotherapy. This effect is possibly due to inhibition of the gastric parietal cell proton pump and suppression of gastric acid production by PPI, especially in aspirin-treated patients. This recommendation has in turn fuelled widespread empiric use of PPIs, especially omeprazole in patients on dual antiplatelet therapy (DAPT) with aspirin and clopidogrel.
Abstract and Introduction
Abstract
There are emerging reports supporting the fact that proton-pump inhibitors competitively inhibit the metabolism of clopidogrel to its active metabolite and diminish its clinical efficacy, especially in patients on long-term dual antiplatelet therapy. In this article, we examine the current evidence and provide interpretation of the results along with practical recommendations for healthcare providers.
Introduction
Consensus guidelines from the American College of Gastroenterology, the American College of Cardiology and the American Heart Association endorse the use of proton-pump inhibitor(s) (PPI) in patients judged to be at higher risk for gastrointestinal (GI) ulceration and related complications. This recommendation is largely based on an observational study reporting PPI cotherapy to be beneficial in reducing the risk of upper GI bleed in patients on clopidogrel monotherapy. This effect is possibly due to inhibition of the gastric parietal cell proton pump and suppression of gastric acid production by PPI, especially in aspirin-treated patients. This recommendation has in turn fuelled widespread empiric use of PPIs, especially omeprazole in patients on dual antiplatelet therapy (DAPT) with aspirin and clopidogrel.