There is ongoing controversy of how clinically significant it is that PPIs reduce the anti-platelet effect of clopidogrel. In this case-control of patients who had a stroke / TIA and who were started on clopidogrel, those who were also on a PPI did not have an increased risk of subsequent stroke or death, compared to those not on a PPI. Similar to the recommendations for patients on clopidogrel for cardiovascular protection, those on clopidogrel for cerebrovascular protection who also require a PPI should probably be on pantoprazole (instead of omeprazole or esomeprazole) (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.