This uncommissioned review article was subject to full peer-review.
Review article: proton pump inhibitors with clopidogrel – evidence for and against a clinically-important interaction
Article first published online: 8 FEB 2011
© 2011 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 33, Issue 7, pages 758–767, April 2011
How to Cite
Disney, B. R., Watson, R. D. S., Blann, A. D., Lip, G. Y. H. and Anderson, M. R. (2011), Review article: proton pump inhibitors with clopidogrel – evidence for and against a clinically-important interaction. Alimentary Pharmacology & Therapeutics, 33: 758–767. doi: 10.1111/j.1365-2036.2011.04585.x
- Issue published online: 2 MAR 2011
- Article first published online: 8 FEB 2011
- Publication data Submitted 19 October 2010 First decision 24 November 2010 Resubmitted 10 January 2011 Accepted 12 January 2011
Aliment Pharmacol Ther 2011; 33: 758–767
Background The treatment of acute coronary syndromes involves a combination of antiplatelet therapies. Proton pump inhibitors are frequently recommended for patients receiving clopidogrel in addition to aspirin, to minimise the risk of bleeding. Several studies have shown that proton pump inhibitors can affect the platelet inhibitory effects of clopidogrel. However, the data on whether this has an effect on clinical outcomes are conflicting and a definitive answer is still awaited.
Aim To provide an overview of the evidence for the pharmacological interaction between proton pump inhibitors and clopidogrel and to discuss whether this interaction translates into adverse clinical outcomes. Despite recent developments, clear consensus is lacking.
Methods A search of the published literature combined with the authors’ knowledge of the field.
Results There is evidence to show that proton pump inhibitors can influence the pharmacodynamics of clopidogrel, but the data suggesting clinical effects are weak and conflicting. Supporting a clinically important interaction are four retrospective studies including over 11 000 patients prescribed both clopidogrel and a proton pump inhibitor. Evidence against a clinically important interaction is derived from over 18 000 patients from seven studies, including the only prospective trial to examine the potential interaction. Confounding variables are relevant and prospective clinical evidence is lacking.
Conclusions Proton pump inhibitors offer clear protection and the concern over clinically relevant interactions with clopidogrel is biologically plausible, but not yet proven.