Combination therapy with clopidogrel and proton-pump inhibitors.

摘要

Michelle O'Donoghue and colleagues1 are to be congratulated on their comprehensive study of the interaction between thienopyridines and proton-pump inhibitors (PPIs), which provides reliable evidence that concomitant use, when clinically indicated, does not affect clinical outcomes.The strategy of adding gastro-protectant treatments to existing cardiovascular therapies, which was the case in more than 33% of participants in the TRITON-TIMI 38. trial, is especially important in the context of gastrointestinal (predominantly peptic ulcer) bleeding. Although O'Donoghue and colleagues present event rates for major and minor bleeds not related to coronary-artery bypass grafting in the TRITON-TIMI 38 trial, such events obviously include a heterogeneous group of safety end-points such as intracranial and procedural bleeds. Are data also available for adjudicated (ideally upper) gastrointestinal bleeds, where PPIs would be expected to have an effect?