Does concurrent use of clopidogrel and PPIs increase CV risk in patients with ACS?
The Journal of Family Practice. 2020 July;69(6):309-310,315 | 10.12788/jfp.0025
July 20, 2020|Family Medicine
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EVIDENCE-BASED ANSWER:
No. Adding a proton pump inhibitor (PPI) in patients taking antiplatelet medications such as clopidogrel for acute coronary syndrome (ACS) doesn’t increase the composite risk of cardiovascular (CV) events: CV death, myocardial infarction (MI), and cerebrovascular accident (CVA) (strength of recommendation: B, randomized, controlled trial [RCT] and prepon-derance of posthoc analyses of large RCTs).
Editor’s takeaway
The best evidence (a large RCT) found that adding a PPI to antiplatelet therapy didn’t alter CV outcomes in patients with ACS, but it did reduce GI bleeds. Hopefully this will give providers the confidence to use PPIs, if clinically indicated, in patients taking antiplatelet therapy with clopidogrel or prasugrel.
