Eduard Veseliny, Peter Jarčuška, Mária Zakuciová, Martin Janíčko
Dual antiplatelet therapy (DAPT) with aspirin (ASA) and clopidogrel significantly reduces the risk of myocardial infarction and recurrent ischemia after an acute coronary syndrome as compared to ASA monotherapy. Due to the increased risk of bleeding in patients on DAPT, current consensus recommendations state that proton pump inhibitors (PPIs) are recommended in patients with prior upper gastrointestinal bleeding and considered appropriate in patients with multiple other risk factors who require DAPT. During the past few years concerns have been raised about the potential for PPIs, especially omeprazole, to decrease the efficacy of clopidogrel, and both the U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA) have issued warnings regarding the concomitant use of these medications. Above all the pharmacodynamic studies support PPI-clopidogrel interaction, whereas the clinical evidence, which is mainly based on nonrandomized, observational studies and secondary analyses of randomized trials, is conflicting. Up to now the clinical validity or relevance of the hypothesized PPI-clopidogrel interaction remains questionable. This article reviews existing data regarding the drug-drug interaction between PPIs and clopidogrel.