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July 1, 2009

Adverse Outcomes Associated With Use of Proton Pump Inhibitors and Clopidogrel

JAMA. 2009;302(1):29-31. doi:10.1001/jama.2009.898

To the Editor: The current management of patients with ACS entails the use of potent antiplatelet medications (aspirin, clopidogrel, IIb/IIIa receptor antagonists), anticoagulants (unfractionated heparin, low-molecular-weight heparin), and sometimes fibrinolytics. These drugs, particularly when used in combination, can make practicing cardiologists worry about an excess risk of upper gastrointestinal (GI) bleeding and therefore prescribe PPIs in an attempt to reduce this risk. The study by Dr Ho and colleagues1 showed that the concomitant use of PPIs and clopidogrel in patients with ACS may increase the risk of adverse outcomes, presumably by reducing the antiplatelet effects of clopidogrel.2

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