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Proton-pump inhibitors (PPIs) are often prescribed to prevent gastrointestinal complications in patients receiving antiplatelet agents such as aspirin and clopidogrel. However, PPIs have metabolic effects on the cytochrome P450 system that might inhibit activation of clopidogrel. This observation raises the following question: Do PPIs interfere with the antiplatelet effects of clopidogrel?
In this controlled trial, 140 patients who underwent coronary stenting received aspirin and clopidogrel therapy; they then were randomized to receive omeprazole (20 mg daily) or placebo. Platelet reactivity (PR), which clopidogrel inhibits, was measured by flow cytometry assay on days 1 and 7 after stenting. On day 1, PR did not differ between groups, but …