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Studies have suggested that clopidogrel's efficacy is weakened if it is used in combination with a proton-pump inhibitor (PPI), given that the drugs compete for CYP2C19 activity. However, earlier retrospective studies might not have fully accounted for the likelihood that patients who receive PPIs are at higher baseline risk for cardiovascular events than are those who do not.
In this retrospective cohort study, based on U.S. claims data, researchers assessed risks for rehospitalization for myocardial infarction (MI) or stent placement among 2066 patients (mean age, 69) who were discharged from hospitals after MI or coronary stent placement; half the patients received clopidogrel alone, and half received it in combination with a PPI. Propens…