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Clopidogrel and PPI use Consensus Report from the American College of Cardiology Foundation, the American College of Gastroenterology, and the American Heart Association

Henry I. Bussey, Pharm.D.
December, 2010

The Clopidogrel and PPI use Consensus Report from the American College of Cardiology Foundation, the American College of Gastroenterology, and the American Heart Association – 2010 is available online at content.onlinejacc.org/cgi/reprint/j.jacc.2010.09.010v1.pdf

The controversial issue of combining omeprazole (and perhaps other proton pump inhibitors) with the antiplatelet agent clopidogrel (brand name Plavix) is reviewed and a consensus statement provided. The bottom line seems to be that PPI therapy is not needed if the patient does not have risk factors for gastrointestinal (GI) bleeding. The consensus report, however, does recommend a PPI for those at increased risk of bleeding, which would include individuals who have a prior history of GI bleeding, advanced age, concurrent anticoagulant and/or antiplatelet therapy (including aspirin and NSAIDs), or glucocorticoid therapy. Although a specific PPI is not recommended, the report does indicate that the strongest data for an interaction between a PPI and clopidogrel is with omeprazole. The potential merits of genetic testing, platelet function testing, and/or using an H2 blocker rather than a PPI are also discussed. Areas that deserve further research are identified and the reader is left with the impression that this statement may be updated as more information becomes available. How the new antiplatelet agents may fit into this discussion is not a major focus of this consensus report.

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Wednesday, March 22, 2017