CYP2C19. In this retrospective trial, the risk of a new hospitalization for infarction or for coronary stent positioning has been assessed in 2066 patients (averagely 69 years of age) discharged after infarction or
coronary revascularization. About half of the subjects had been treatedwith clopidogrel alone and the other half with a contemporary assumption of a PPI. During follow-up, lasted one year, patients under combined therapy have presented a higher risk for a new hospitalization for infarction (9.7 vs. 4.1 events/100people/year) or for a new coronary stent procedure (27.6 vs. 14.3 events/100 people/year).
The trial only confirms what has been already affirmed: the association with a PPI strongly decreases the efficacy of clopidogrel. We must also note that some trials have stated that pantoprazole would have a much
lower antagonist action than other PPIs, but in this trial this difference was not shown, so, in case you need an anti-secretion drug associated with clopidogrel, it is much more cautious to use the old ranitidine or local acid tampons.
