Insight of drug interaction between proton pump inhibitors and clopidogrel

Some clinical researches showed that combination use of proton pump inhibitors(PPIs) and clopidogrel might be associated with increased risks of cardiovascular events in patients with acute coronary syndrome or after percutaneous coronary intervention.This article discussed and analyzed the controversial questions regarding clopidogrel and CYP2C19 polymorphism,the interaction between PPIs and clopidogrel in pharmacology and clinical effect and the possible suggestions by reviewing the published studies.A meta-analysis of pharmacokinetic studies showed that PPIs might attenuate the antiplatelet effect of clopidogrel.Ten observational researches with poor quality stated that combination use of PPIs and clopidogrel might increase the risk of cardiovascular events,while three other low quality observational studies,five moderate quality observational studies and one high quality randomized controlled trial found no significant relationship between combination use of PPIs and clopidogrel and increased risks of cardiovascular events.