Prescribing proton pump inhibitor and clopidogrel together: Current state of recommendations

Research output: Contribution to journalReview article

14 Scopus citations

Abstract

Purpose of review: Conflicting evidence has contributed to confusion regarding the safety of co-prescribing a proton pump inhibitor (PPI) and clopidogrel. This review will quantify the risk of gastrointestinal bleeding associated with common cardioprophylactic regimens, review the evidence regarding a PPI-clopidogrel interaction and assess its clinical relevance, and reinforce best-practice recommendations for gastrointestinal bleeding prevention among patients prescribed clopidogrel. Recent findings: The COGENT trial confirmed a substantial reduction in gastrointestinal bleeding risk without apparent increase in cardiovascular events when clopidogrel was co-prescribed with omeprazole. These data are consistent with secondary data analyses of large cardiovascular trials and well adjusted observational studies that also failed to confirm a consistent, clinically relevant increase in cardiovascular endpoints or mortality. Individual genetic variations in drug metabolism may contribute to increased cardiac event rates observed in small subsets of the population when PPI is co-prescribed. In the future, pharmacogenomics and point-of-care testing will likely play an emerging role in individualizing prescription strategy. Summary: A pragmatic approach dictates an explicit risk-benefit assessment prior to co-prescription to maximize cardiac benefit and minimize the risk of gastrointestinal bleeding.

Original languageEnglish (US)
Pages (from-to)558-564
Number of pages7
JournalCurrent Opinion in Gastroenterology
Volume27
Issue number6
DOIs
StatePublished - Oct 1 2011

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Keywords

  • antiplatelets
  • cardiac patients
  • clinical practice recommendations
  • consensus statement documents
  • gastrointestinal bleeding risk prevention
  • proton pump inhibitors
  • thienopyridine

ASJC Scopus subject areas

  • Gastroenterology

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