The risk of rehospitalization for myocardial infarction (MI) almost doubled in patients treated with both a proton pump inhibitor (PPI) and clopidogrel (Plavix) after acute MI or coronary stent deployment, data from a retrospective cohort study showed. PPIs are frequently used to reduce the risk of gastrointestinal bleeding in patients treated with clopidogrel. However, a growing volume of evidence has suggested that PPIs might reduce clopidogrel's efficacy, the authors wrote. In one recent study, patients treated with omeprazole (Prilosec) in addition to aspirin and clopidogrel had a significantly higher platelet reactivity index score after seven days of treatment than patients who didn't get the PPI (J Am Coll Cardiol 2008; 51: 256-60). However, a subgroup analysis of a large clinical trial showed no increased risk of adverse events in patients who received clopidogrel with or without a PPI (Circulation 2008; 118(suppl 2): Abstract 3999). |