Expert position paper on use of proton pump inhibitors in patients with cardiovascular disease and antithrombotic therapy

Source: Eur Heart J Area: News The European Society of Cardiology NSTEMI and STEMI guidelines and an ACCF/ACG/AHA consensus document recommend treatment with proton pump inhibitors (PPIs) in patients treated with dual antiplatelet treatment (DAPT) during the initial phase of an acute coronary syndrome (ACS), particularly in patients with a history of GI bleeding or peptic ulcer. Several studies have raised concerns that many PPIs, especially omeprazole, might diminish the antiplatelet effects of clopidogrel, most likely through inhibition of CYP2C19 and, consequently, the conversion of clopidogrel into its active metabolite.   This position paper reviews the pharmacokinetic background of the interactions between these drugs, and their consequences on clinical outcomes, and presents suggestions for management of this issue.   The following findings are reported:   . No conclusive evidence to discourage PPIs with clopidogrel, but evidence of benefit in terms of bleeding ...
Source: NeLM - Cardiovascular Medicine - Category: Cardiology Source Type: news