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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.2009.896

To the Editor: Dr Ho and colleagues1 reported that concomitant use of clopidogrel and a proton pump inhibitor (PPI) after discharge from hospital for acute coronary syndrome (ACS) was associated with an increased risk of rehospitalization for ACS, compared with use of clopidogrel without PPI. Based on their observations, the authors concluded that, although causality cannot be claimed, PPIs should be used based on clear clinical indications rather than prophylactic prescription. Reconsideration of prophylactic prescription of PPIs in patients with ACS has been ongoing.2 However, the recent American College of Cardiology Foundation/American College of Gastroenterology/American Heart Association (ACCF/ACG/AHA) guidelines still recommend using PPIs for aspirin users with a history of myocardial infarction, many of whom are also using clopidogrel.3