Clopidogrel and Proton-Pump Inhibitors: How Much of a Problem?

Recent studies have suggested an interaction between clopidogrel and proton-pump inhibitors (PPIs) that might attenuate clopidogrel activity. To assess the clinical relevance of this interaction, researchers studied 18,000 people (age, ≥65) in the U.S. and Canada who had been newly treated with clopidogrel after acute coronary syndromes or percutaneous coronary intervention.

In pooled analyses, rates of subsequent hospitalizations for myocardial infarction (2.6% vs. 2.1%), death (1.5% vs. 0.9%), and revascularization (3.4% vs. 3.1%) were slightly higher in PPI users than in nonusers. In propensity score–adjusted analyses, point estimates for rates of MI or death (1.22; 95% confidence interval, 0.99–1.51), death (1.20; 95% CI, 0.84–1.70), and…