Clopidogrel Case Study

Clopidogrel reduces the rate of cerebrovascular and cardiovascular events in patients with acute coronary syndrome (ACS), recent acute myocardial infarction (AMI) or stroke, and those with peripheral artery disease. Clopidogrel itself is a pro-drug that need to converse to active form through CYP2C19. This has led to significant concern that drugs inhibiting CYP2C19 (like PPIs) might reduce clopidogrel’s effectiveness. 1

Siller-Matula et al conducted a meta-analysis study to evaluate whether PPIs negatively affect clinical outcome (combined major adverse cardiac events, myocardial infarction, stent thrombosis, death and gastrointestinal bleeding) in patients (n=159,138) treated with clopidogrel. Patients use clopidogrel with PPI was associated with a 29% relative risk increase (RR=1.29; 95% CI=1.12-1.53) of combined major cardiovascular events and a 31% relative risk increase of MI (RR=1.31, 95% CI=1.12-1.53) vs. no PPI use. In addition, patient use clopidogrel with PPI was not associated with mortality (RR=1.04, 95% CI=0.93-1.16). 2

Bhatt et al conducted a prospective …show more content…
pantoprazole). 4 But in a recent study, Leonard CE conducted a propensity score-adjusted cohort study to elucidate the risk of ischemic stroke among concomitant users of clopidogrel and individual PPIs (n=325,559). A total of 1667 ischemic stroke events were identified in the study (annual incident of 2.4%, 95%CI 2.3-2.5). Adjusted hazard ratios were 0.99 (0.83-1.18) for esomeprazole, 1.05 (0.91-1.20) for lansoprazole, 0.98 (0.85-1.15) for omeprazole and 0.85 (0.63-1.13) for raberprazole, each vs. pantoprazole. Pantoprazole is a PPI that thought not interact with clopidogrel, but this study shows that there is no increased risk of ischemic stroke of concomitant use of clopidogrel with esomeprazole, lansoprazole, omeprazole, or rabeprazole when compared with