CardioExchange Archive

Despite recent warnings by the FDA, an expert consensus document released jointly by the AHA, the ACC, and the American College of Gastroenterology states that it is acceptable to use proton pump inhibitors (PPIs) with thienopyridines like clopidogrel in patients at high risk for upper GI bleeds. The statement does not recommend routine use of PPIs in patients on antiplatelet therapy.

Although pharmacokinetic and pharmacodynamic studies suggest that the antiplatelet effects of clopidogrel can be reduced  by a PPI, “it is not established that changes in these surrogate endpoints translate into clinically meaningful differences,” according to the statement. However, the statement acknowledges that “a clinically important interaction cannot be excluded, particularly in certain subgroups, such as poor metabolizers of clopidogrel.”

Finally, the clinical role for pharmacogenomic or platelet function testing “has not yet been established.”

“The flurry of conflicting data published following the 2008 Expert Consensus Document left many practitioners confused,” said Neena Abraham, the chair of the writing committee, in a press release. “However, much of the published data used results of platelet function tests as surrogate markers of cardiovascular risk. The differences in drug levels and in platelet function studies caused concern about an adverse drug interaction, but the clinical significance of these laboratory test results has not been substantiated when held to the higher scientific standard of large patient studies with clinically relevant endpoints, such as heart attacks or strokes.”