Current standings of the proton pump inhibitor and clopidogrel co-therapy: review on an evolving field with the eyes of the gastroenterologist

Abstract

The negative effect of proton pump inhibitors (PPI) on the antiplatelet function of clopidogrel has only recently emerged on the horizon of cardiological interest. To date, one can only find 10 peer-reviewed papers on PubMed on this issue, although the increasing activity is unquestionable. Besides publications, conference reports and official web sites are therefore important sources of information. In this field, the first step was made by an experimental study proving the adverse effect of omeprazole on clopidogrel function. Consequently, retrospective studies reported a significant increase of major adverse cardiovascular events among patients taking the combination of omeprazole and clopidogrel. Based on the paucity of quality data and limitations of studies conducted on this interaction, some are still reluctant to confirm the pathogenic role of PPI and clopidogrel interaction in the development of reinfarctions. One step further ahead, admitting the risks related to the combination of these two drugs, the next question to be decided is whether we face a class effect, or thanks to the different metabolic pathways there are indeed relevant differences among PPIs. There is a lot at stake, since the volume of patients taking the dual aspirin-clopidogrel antiplatelet therapy and thereby needing gastroprotection is immense, rendering a huge responsibility to the societies and committees who are making proposals on the selection of appropriate PPIs.