%0 Journal Article
%T The potential interaction between clopidogrel and proton pump inhibitors: a systematic review
%A Joao Lima
%A James M Brophy
%J BMC Medicine
%D 2010
%I BioMed Central
%R 10.1186/1741-7015-8-81
%X A systematic review of all studies reporting clinical outcomes was performed using an electronic literature search of the MEDLINE and EMBASE databases, abstracts from the major cardiology conferences and a hand-search of bibliographies from identified articles. Each study was evaluated for its risk of bias according to a prespecified quality measure scale.A total of 18 studies were identified. Ten of 13 studies judged to be of low scientific quality reported a statistically positive interaction between clopidogrel and the general class of PPIs, and each concluded this was likely a clinically meaningful effect. None of the five studies judged to be of moderate or high quality reported a statistically significant association. Multiple sources of heterogeneity (that is, different populations, outcomes assessed, drug exposure methods and study quality) prevented a formal quantitative analysis of all studies. An increased risk of bias was observed in the positive studies, resulting in an inverse correlation between study quality and a reported statistically positive interaction (10/13 versus 0/5; P = p = 0.007). There was also no clinical evidence for a positive interaction according to specific PPIs.The observed association between clopidogrel and PPIs is found uniquely in studies judged to be of low quality and with an increased risk of bias. High-quality evidence supporting a clinically significant clopidogrel/PPI interaction is presently lacking.Clopidogrel is a widely prescribed thienopyridine for the prevention of atherothrombotic complications following acute coronary syndromes (ACS) or percutaneous coronary interventions (PCIs) [1]. Clopidogrel is a prodrug that has no intrinsic antiplatelet activity without activation by hepatic metabolism through the cytochrome P450 (CYP) system [2]. Multiple CYP enzymes have been implicated in this process, but recently the CYP2C19 enzyme has assumed predominance as it is involved in both sequential oxidative steps [3]. The po
%U http://www.biomedcentral.com/1741-7015/8/81