Proton-Pump Inhibitors and Clopidogrel: Bad Company?

Proton-pump inhibitors (PPIs) are often prescribed to minimize gastrointestinal bleeding in patients taking clopidogrel after acute coronary syndromes (ACS). However, findings from small studies suggest that PPIs may reduce clopidogrel’s efficacy. To determine whether such an interaction could have important clinical effects, investigators assessed outcomes in 8025 patients with ACS who were discharged from Veterans Affairs hospitals nationwide and who received clopidogrel with or without a PPI. The primary outcome was the composite of all-cause mortality and rehospitalization for ACS.

A majority (63.9%) of the patients were prescribed a PPI in conjunction with clopidogrel. In multivariable analysis, the use of a PPI with clopidogrel was ass…