Concomitant treatment with clopidogrel and proton pump inhibitors in patients with recent myocardial infarction Review article

Abstract

In post-MI patients oral antiplatelet therapy including clopidogrel decreases ischemic risks at the cost of an increase in the number of GI bleeding complications. Recently published expert consensus document recommends the use of proton pump inhibitors (PPI) as a form of gastroprotection in individuals receiving dual antiplatelet therapy. Most PPIs interfere with clopidogrel pharmacokinetics and thus potentially inhibit its antiplatelet effect. In the presented study authors evaluated the clinical significance of this drug interaction. They conducted a populationbased nested case-control study among patients with recent MI receiving clopidogrel following hospital discharge. The group of cases comprised of patients readmitted for recurrent MI within 90 days after initial discharge. A cohort of 13 636 patients treated with clopidogrel was established, out of which researchers identified 734 cases and 2057 event-free controls. In multivariable analysis current treatment with a PPI was associated with an increased rate of reinfarction (adjusted OR=1,27, 95%CI: 1,03–1,57), while a more remote exposure to PPI did not portend such a risk. The only PPI which usage was not associated with readmission for MI was pantoprazole (adjusted OR=1,02, 95%CI: 0,70–1,47). Researchers conclude that in post-MI patients receiving clopidogrel, concomitant therapy with a PPI other than pantoprazole was associated with an increased risk of recurrent MI and thus such a combination should be avoided when possible.