Inhibition of the antithrombotic effects of clopidogrel by proton pump inhibitors: facts or fancies?

摘要: Clopidogrel plus aspirin is considered the antiplatelet treatment of choice in patients with acute coronary syndrome, whether or not they are undergoing a percutaneous intervention (PCI). The same mandatory all PCI stent implantation. pro-drug that needs metabolic activation through cytochrome P450-dependent pathway, an extensive involvement CYP 2C19 isoenzyme. Proton pump inhibitors (PPIs) reduce risk gastrointestinal bleeding receiving dual therapy. In past two years some scientific evidences have suggested possible negative interference PPIs on effect clopidogrel because competitive inhibition Few studies testing platelet reactivity both and PPI demonstrated reduced inhibitory association aggregation. Moreover, results from retrospective observational shown higher incidence major cardiovascular events PPIs. These data been confirmed neither by only prospective randomized study comparing omeprazole alone, nor analysis TRITON TIMI 38 trial, where did affect clinical outcome given prasugrel. Nevertheless US Food Drug Administration (FDA) European Medicines Agency (EMEA) discouraged concomitant use Important questions concerning true between classes drugs still remain unanswered need to be addressed adequately powered studies.