O’Donahue ML, Braunwald E, Antman EM et al.
Brigham and Women’s Hospital, Boston, MA, USA.
Lancet 2009;374:989–97.
Editor’s note: Clopidogrel and prasugrel are antiplatelet agents that are widely used for the prevention of stent occlusion and in patients who are at high risk of thromboembolic events. Several recent observational studies have indicated that the concurrent use of proton pump inhibitors (PPIs) limits the efficacy of these drugs, perhaps through interactions with the cytochrome p450 system that is necessary to form the active metabolites of these agents (
J Am Coll Cardiol 2008;51:256–60,
JAMA 2009;301:937–44). PPIs are commonly co-prescribed with these antiplatelet agents to provide protection against gastrointestinal bleeding, and this issue has therefore assumed great clinical relevance. Both the European Medicines Agency and the US Food and Drug Administration have recently expressed their concerns about the clinical importance of the interactions between these two types of drug.