There has been ongoing controversy regarding the clinical meaningfulness of PPI’s attenuation of the anti-platelet effect of clopidogrel. In this large retrospective cohort of over 20,000 patients discharged on clopidogrel (from a state-wide medicaid database), researchers found those also discharged on a PPI had a 50% reduced risk of re-hospitalization with GI bleed, but no significantly increased risk of a cardiovascular event. This study and others suggest that PPI’s and clopidogrel can be used concomitantly, but avoiding unnecessary PPI’s in patients at high risk for cardiovascular events is still prudent (abstract). In addition, pantoprazole is probably a better choice than omeprazole, if a PPI is required (abstract)
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.