The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Proton Pump Inhibitors with Clopidogrel: Is There Benefit or Harm?

프로톤펌프억제제와 클로피도그렐(clopidogrel) 병용투여는 안전한가?

  • Jeon, Seong-Woo (Department of Internal Medicine, Kyungpook National University School of Medicine)
  • 전성우 (경북대학교 의학전문대학원 내과학교실)
  • Published : 2011.04.01
⟨ Previous Next ⟩

Abstract

The treatment of acute coronary syndromes involves a combination of antiplatelet therapies. Proton pump inhibitors (PPIs) are often recommended for prophylaxis of gastrointestinal bleeding. Recent studies have shown that the cardiovascular harmful effects of the combination therapy with these two drugs cause serious results in patients with acute coronary syndrome. However, the data on this subject, especially on the clinical outcomes, are conflicting. Based on the available data, the decision to prescribe a PPI to a patient on clopidogrel should be done after evaluation of the cardiovascular risk and the gastrointestinal benefit. Further prospective randomized trials are needed to jump to the conclusions.

Keywords

References

  1. Ibanez L, Vidal X, Vendrell L, Moretti U, Laporte JR. Upper gastrointestinal bleeding associated with antiplatelet drugs. Aliment Pharmacol Ther 2006;23:235-242. https://doi.org/10.1111/j.1365-2036.2006.02759.x
  2. Disney BR, Watson RD, Blann AD, Lip GY, Anderson MR. Review article: proton pump inhibitors with clopidogrel - evidence for and against a clinically-important interaction. Aliment Pharmacol Ther 2011;33:758-767. doi: 10.1111/j.1365-2036.2011.04585.x.
  3. Mega JL, Close SL, Wiviott SD, et al. Cytochrome p-450 polymorphisms and response to clopidogrel. N Engl J Med 2009;360:354-362. https://doi.org/10.1056/NEJMoa0809171
  4. Gilard M, Arnaud B, Le Gal G, Abgrall JF, Boschat J. Influence of omeprazol on the antiplatelet action of clopidogrel associated to aspirin. J Thromb Haemost 2006;4:2508-2509. https://doi.org/10.1111/j.1538-7836.2006.02162.x
  5. Gilard M, Arnaud B, Cornily JC, et al. Influence of omeprazole on the antiplatelet action of clopidogrel associated with aspirin: the Randomized, Double-blind OCLA (Omeprazole CLopidogrel Aspirin) Study. J Am Coll Cardiol 2008;51:256-260. https://doi.org/10.1016/j.jacc.2007.06.064
  6. Juurlink DN, Gomes T, Ko DT, et al. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ 2009;180:713-718. https://doi.org/10.1503/cmaj.082001
  7. Ho PM, Maddox TM, Wang L, et al. Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome. JAMA 2009;301:937-944. https://doi.org/10.1001/jama.2009.261
  8. Ray WA, Murray KT, Griffin MR, et al. Outcomes with concurrent use of clopidogrel and proton-pump inhibitors: a cohort study. Ann Intern Med 2010;152:337-345. https://doi.org/10.7326/0003-4819-152-6-201003160-00003
  9. Bhatt DL, Cryer BL, Contant CF, et al. Clopidogrel with or without omeprazole in coronary artery disease. N Engl J Med 2010;363:1909-1917. https://doi.org/10.1056/NEJMoa1007964