Clopidogrel and PPIs: heartwire collection

Clopidogrel and PPIs

Proton-pump inhibitors have been prescribed to reduce the gastrointestinal risks of clopidogrel--until a range of small studies suggested that this combination might actually increase the risk of cardiovascular events. The FDA took the unusual step of issuing a warning about the combination, but many people believe the evidence simply doesn't warrant concerns about the combo and may even be putting patients at risk.

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Showing 1 - 25 of 27 documents.

Clinical cardiology

Esomeprazole, but not rosuvastatin, affects clopidogrel post-PCI: SPICE

5 COMMENTS - Oct 27, 2011 15:45 EDT

Esomeprazole is "at least as bad" as omeprazole in reducing the antiplatelet effects of clopidogrel, a new randomized trial shows, but when it comes to statin effects, SPICE found no differences between rosuvastatin and atorvastatin on platelet function.

Acute Coronary Syndromes

PPIs and clopidogrel: Could symptom confusion explain CV risk signal?

Mar 9, 2011 17:15 EST

Authors of yet another analysis trying to get to the bottom of the real or perceived risk of combining clopidogrel with a proton-pump inhibitor have a new and provocative theory as to just where the signal of increased events may be coming from.

Interventional/Surgery

No PPI attenuation of clopidogrel antiplatelet effects: MI registry analysis

3 COMMENTS - Jan 26, 2011 17:15 EST

The observation was independent of whether patients carried a gene variant also associated with reduced clopidogrel effectiveness. The findings add yet more observational data to a debate that really could use a solid prospective, randomized trial.

Clinical cardiology

PPIs and antiplatelets: New consensus document

5 COMMENTS - Nov 8, 2010 16:00 EST

The document recommends the use of proton-pump inhibitors in patients taking thienopyridine antiplatelet agents at high risk of GI bleeding but not in those at low risk; exactly how to define high- and low-risk patients is left to the individual physician.

Interventional/Surgery

COGENT published: Lead investigator says he'll use a PPI in patients on dual antiplatelet therapy

5 COMMENTS - Oct 6, 2010 17:00 EDT

Patients on dual antiplatelet therapy had a significant reduction in GI events with omeprazole and no increase in cardiovascular events in the first randomized trial of PPI use with clopidogrel. And a new mechanistic study suggests that the clopidogrel-omeprazole interaction may be dose dependent.

Interventional/Surgery

Clopidogrel-PPI interaction: Mechanistic studies that led to FDA warning now published

9 COMMENTS - Sep 20, 2010 13:00 EDT

But cardiologists continue to debate whether these results, which show a definite interaction, are clinically relevant.

Interventional/Surgery

Clopidogrel-PPI interaction more relevant in noncarriers of CYP2C19 loss-of-function gene

4 COMMENTS - Sep 9, 2010 10:00 EDT

A small pharmacodynamic study has found that noncarriers of the CYP2C19 loss-of-function alleles were more susceptible than carriers to the effects of the PPI-clopidogrel interaction.

New meta-analysis: <i>CYP2C19*2</i> carriers at higher risks of events on clopidogrel

Interventional/Surgery

New meta-analysis: CYP2C19*2 carriers at higher risks of events on clopidogrel

Jul 5, 2010 17:30 EDT

The analysis also looked at the effect of PPIs and found that they were associated with an increased risk of events only in high-risk patients.

Interventional/Surgery

PPIs, clopidogrel, and stent implantation: No risk? FDA data coming soon

6 COMMENTS - Jun 1, 2010 17:30 EDT

Another retrospective analysis, this time in stented patients, shows no significant increases in risk of death, ACS, or stent thrombosis in patients taking concomitant proton-pump inhibitors, mostly pantoprazole. But one expert says no conclusions can be made until the FDA reveals the data it used to decide that a warning was warranted.

Interventional/Surgery

PPIs plus clopidogrel associated with more MIs

1 COMMENT - Apr 27, 2010 13:30 EDT

UPDATED WITH COMMENTARY // Yet another study suggests increased cardiac events with this combination and that pantoprazole is implicated just as much as other PPIs. But while this study matched patients with propensity scoring, commentators have warned it was still retrospective and therefore will have limitations.

Thrombosis

Still no answers in largest review on clopidogrel/PPIs

3 COMMENTS - Apr 13, 2010 17:00 EDT

The largest meta-analysis to date on whether treatment with proton-pump inhibitors adversely affects cardiovascular outcomes in patients receiving clopidogrel still provides no firm answers; more research is necessary, say the authors. However, they and other experts conclude that any risk is likely small and that those on clopidogrel with a high likelihood of gastrointestinal bleeding should still receive a PPI.

Editorial series

The FDA and clopidogrel: Caution or confusion?

6 COMMENTS - Mar 31, 2010 09:20 EDT

Watch Drs Harlan Krumholz, Peter Berger, and Rita Redberg, discuss the recent controversial move by the FDA requiring a boxed warning on clopidogrel.

Clinical cardiology

New studies cast doubt on clopidogrel-PPI interaction

7 COMMENTS - Mar 22, 2010 16:00 EDT

Treatment with proton-pump inhibitors did not affect clinical outcomes in patients receiving clopidogrel after PCI in a new study.

Clinical cardiology

Keep clopidogrel-PPI interaction in perspective; expert predicts more to come from the FDA

4 COMMENTS - Nov 26, 2009 13:15 EST

A new observational study finds a small but statistically insignificant effect of PPIs on the antiplatelet effects of clopidogrel. An accompanying editorialist says the interaction is real but can be limited in clinical practice. However, the previous advice to stagger doses of clopidogrel and PPIs no longer stands, he says, predicting that physicians have not heard the last of this issue.

Clinical cardiology

Cardiologists shocked by new FDA alert on clopidogrel-PPI interaction

Nov 17, 2009 15:45 EST

The FDA has issued a new warning on an interaction between clopidogrel and the PPI omeprazole and other drugs that inhibit the CYP2C19 enzyme, just weeks after the only randomized trial on this issue reported no such interaction.

Clinical cardiology

COGENT: No CV events but significant GI benefits of PPI omeprazole

14 COMMENTS - Sep 24, 2009 16:30 EDT

The randomized controlled trial results should put a stop to alarmist headlines about PPIs blunting efficacy of antiplatelet drugs, experts say. By withholding PPIs, physicians are doing more harm than good, the results suggest.

Interventional/Surgery

Omeprazole, but not pantoprazole, inhibits clopidogrel's platelet response

5 COMMENTS - Sep 15, 2009 11:15 EDT

The use of omeprazole significantly reduced the antiplatelet activity of clopidogrel, even with a high maintenance dose of the drug, and other PPIs, such as pantoprazole, should be preferred in clopidogrel-treated patients, according to investigators.

Acute Coronary Syndromes

TRITON-TIMI 38 reassures on PPI interaction with thienopyridines

Sep 1, 2009 05:20 EDT

Data from a second, much smaller study (PRINCIPLE-TIMI 44) show a modest reduction in platelet inhibition with both clopidogrel and prasugrel in patients taking a PPI, but the TRITON results suggest that this is not clinically relevant.

Acute Coronary Syndromes

H₂ antagonists an alternative to PPIs to prevent bleeds in aspirin users

2 COMMENTS - Jul 10, 2009 16:30 EDT

New trial data suggest the H₂ antagonist famotidine is effective in the prevention of gastric bleeds in patients taking aspirin, offering a therapeutic alternative to proton-pump inhibitors, say the authors. An accompanying editorialist says that head-to-head trials of the two approaches are needed to determine which is the most effective.

Acute Coronary Syndromes

EMEA issues warning on possible clopidogrel-PPI interaction, but is there really a problem?

3 COMMENTS - Jun 19, 2009 14:00 EDT

The European Medicines Agency has now followed suit with the US FDA and issued a warning discouraging concomitant use of clopidogrel and PPIs, but some experts believe the issue has been overhyped.

Interventional/Surgery

Proton-pump inhibitors blunt efficacy of clopidogrel in diabetics with coronary stents

1 COMMENT - Jun 10, 2009 12:00 EDT

PPIs increase the risk of cardiovascular events 44% in diabetics with stents on clopidogrel.

Interventional/Surgery

Possible "class effect" for proton-pump inhibitors on top of clopidogrel therapy

12 COMMENTS - May 6, 2009 17:15 EDT

UPDATED // One-year risk of cardiovascular events is 50% higher in patients taking a proton-pump inhibitor on top of clopidogrel and similar for four PPIs, according to a retrospective cohort study of more than 16 700 patients who received clopidogrel poststenting.

Acute Coronary Syndromes

Platelet-function test finds fault with omeprazole/clopidogrel combo, but not with other PPIs

4 COMMENTS - Apr 10, 2009 11:45 EDT

Platelet aggregation was significantly higher in patients taking omeprazole than in patients not taking a PPI or in patients taking pantoprazole or esomeprazole.

Acute Coronary Syndromes

More data support adverse clopidogrel and proton-pump inhibitor interaction

13 COMMENTS - Mar 3, 2009 16:00 EST

Among discharged ACS patients prescribed the two drugs, there was a 25% increased risk of adverse clinical outcomes compared with those taking clopidogrel alone. (Ho PM et al. JAMA 2009; 301:937-944.)

Acute Coronary Syndromes

Increased risk of reinfarction with clopidogrel and proton-pump inhibitors

10 COMMENTS - Jan 29, 2009 17:30 EST

UPDATED WITH COMMENTARY // The findings support suspicions that the drug combination diminishes the beneficial effect of the antiplatelet therapy and increases the risk of future events, say researchers. (Juurlink DN et al. CMAJ; published online before print January 28, 2009.)

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