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Adding PPI to clopidogrel raises vascular event risk

By Lilian Anekwe

Patients who receive clopidogrel plus a proton-pump inhibitor (PPI) have a higher risk of being rehospitalised for vascular events than those on clopidogrel alone, according to a US study.

A retrospective cohort study of the health insurance data of more than 2,000 patients discharged from hospital after either a myocardial infarction or coronary stent replacement and treated with clopidogrel plus PPI, or clopidogrel alone.

Patients who received clopidogrel plus a PPI had a 93% higher risk of rehospitalisation for myocardial infarction and a 64% higher risk of rehospitalisation for myocardial infarction or coronary stent replacement than those on clopidogrel alone.

Study leader Dr Scott Ramsey, internal medicine physician at the University of Washington, said: 'The results of this study, and others noting possibly reduced efficacy of clopidogrel if used with PPIs, mean European Medicines Agency advise to discourage concomitant use unless necessary is prudent.'

Arch Intern Med. 2010;170(8):704-710.

Patients who receive clopidogrel plus a proton-pump inhibitor have a higher risk off being hospitalised for vascular events Patients who receive clopidogrel plus a proton-pump inhibitor have a higher risk off being hospitalised for vascular events

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