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Recent studies have suggested that proton-pump inhibitors (PPIs) can interfere with the antiplatelet effects and clinical effectiveness of clopidogrel after percutaneous coronary intervention (PCI), perhaps by inhibiting hepatic conversion of the clopidogrel prodrug to its active metabolites (JW Gen Med Mar 12 2009). To assess interactions among PPI use, platelet function, and cardiovascular outcomes, researchers examined data from two industry-sponsored randomized trials in which clopidogrel was compared with a newer thienopyridine, prasugrel, in patients with acute coronary syndromes who underwent planned PCIs.
In one trial, 201 patients were randomized to prasugrel or to high-dose clopidogrel; 53 patients (26%) were taking PPIs at randomi…