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The interaction between clopidogrel and proton-pump inhibitors is "clinically unimportant," researchers conclude in BMJ.
The researchers used U.K. registries to study some 24,000 acute coronary syndrome patients who were prescribed both aspirin and clopidogrel; half the patients also received a PPI at some point during the study.
After nearly a year's follow-up, incident MI or all-cause mortality had occurred significantly more often during PPI use than nonuse (11% vs. 8% of patients). However, a self-controlled case series analysis — performed to eliminate confounding from differences between patients — showed no significant association between PPI use and MI (rate ratio, 0.75).
These findings suggest that the PPI–clopidogrel interaction "does not result in clinical harm," the researchers write. They add that concomitant use of PPIs with clopidogrel and aspirin "is well proved to prevent harm through gastrointestinal bleeding, and we should continue to consider proton-pump inhibitors as important prophylactic drugs in patients at high risk."