PPIs and Clopidogrel: The Band Plays On…………

Controversy currently surrounds the issue of proton pump inhibitor (PPI)-clopidogrel co-therapy. Some studies have reported that PPIs increase the rate of adverse cardiovascular outcomes in clopidogrel users, although others have not confirmed this. The Food and Drug Administration has advised against the use of certain PPIs by patients who are on clopidogrel. In the first outcomes study from Europe to examine this issue, van Boxel and colleagues found an increased rate of adverse cardiovascular--and gastrointestinal--outcomes among clopidogrel users taking a PPI. The most plausible explanation for this is that it reflects channeling bias.