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In the COGENT trial (JW Cardiol Oct 6 2010), the proton-pump inhibitor (PPI) omeprazole prevented adverse gastrointestinal (GI) events — and did not raise cardiovascular risk — in patients who were receiving clopidogrel plus aspirin. However, only 4% of those patients had histories of GI bleeding or peptic ulcers. Now, investigators in Taiwan have studied 165 older adults who differed from COGENT patients in two ways: (1) all had histories of peptic ulcers (33% with bleeding), and (2) all required clopidogrel and could not take aspirin for various reasons.
Patients were randomized to receive either clopidogrel alone or esomeprazole (Nexium) plus clopidogrel; to lower the chance of interaction, patients received esomeprazole in the morning an…