Conflicting Evidence: What's a Clinician to Do?
Authors: Joao Paulo de Aquino Lima
Journal: Annals of Internal Medicine (2010)

Editorials21 September 2010Conflicting Evidence: What's a Clinician to Do?Joao Paulo de Aquino Lima and James M. Brophy, MD, PhDJoao Paulo de Aquino LimaFrom Federal University of Ceará School of Medicine, Fortaleza, Brazil; and McGill University, Montreal, Quebec H3A 1A1, Canada.Search for more papers by this author and James M. Brophy, MD, PhDFrom Federal University of Ceará School of Medicine, Fortaleza, Brazil; and McGill University, Montreal, Quebec H3A 1A1, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-153-6-201009210-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this issue, Charlot and colleagues (1) use Danish national administrative databases to analyze the association between cardiovascular death, myocardial infarction, or stroke and the concomitant use of proton-pump inhibitors (PPIs) and clopidogrel in patients who have had a myocardial infarction. They report no evidence for a specific drug interaction and find that PPIs were associated with an increased risk for adverse cardiovascular outcomes independent of clopidogrel use. As summarized by Charlot and colleagues, several other studies (2–6) have been published on this subject, and—despite conflicting results—regulatory bodies have issued edicts (7, 8) that warn about a clinically significant drug ...References1. Charlot M, Ahlehoff O, Norgaard ML, Jørgensen CH, Sørensen R, Abildstrøm SZ, et al. Proton-pump inhibitors are associated with increased cardiovascular risk independent of clopidogrel use. A nationwide cohort study. Ann Intern Med. 2010;153:378-86. LinkGoogle Scholar2. Dunn SP, Macaulay TE, Brennan DM, Campbell CL, Charnigo RJ, Smyth SS, et al. Abstract 3999: Baseline proton pump inhibitor use is associated with increased cardiovascular events with and without the use of clopidogrel in the CREDO Trial. Circulation. 2008;118:S815. CrossrefGoogle Scholar3. Ho PM, Maddox TM, Wang L, Fihn SD, Jesse RL, Peterson ED, et al. 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Public Statement on Interaction between clopidogrel and proton-pump inhibitors. London: European Medicines Agency; 2010. Accessed at www.ema.europa.eu/humandocs/PDFs/EPAR/Plavix/17494810en.pdf on 13 August 2010. Google Scholar8. U.S. Food and Drug Adminstration. Public-health advisory: Updated safety information about a drug interaction between clopidogrel bisulfate (marketed as Plavix) and omeprazole (marketed as Prilosec and Prilosec OTC). Silver Spring, MD: U.S. Food and Drug Administration; 2009. Accessed at www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/PublicHealthAdvisories/ucm190825.htm on 13 August 2010. Google Scholar9. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK; Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. 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[PMID: 17659194] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Federal University of Ceará School of Medicine, Fortaleza, Brazil; and McGill University, Montreal, Quebec H3A 1A1, Canada.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1709.Corresponding Author: James M. Brophy, MD, PhD, Royal Victoria Hospital, 687 Pine Avenue West, R4.12, Montreal, Quebec H3A 1A1, Canada; e-mail, james.[email protected]ca.Current Author Addresses: Mr. de Aquino Lima: 650 Visconde de Maua Street, Fortaleza, Ceará, 60125-160, Brazil.Dr. Brophy: Royal Victoria Hospital, 687 Pine Avenue West, R4.12, Montreal, Quebec H3A 1A1, Canada. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoProton-Pump Inhibitors Are Associated With Increased Cardiovascular Risk Independent of Clopidogrel Use Mette Charlot , Ole Ahlehoff , Mette Lykke Norgaard , Casper H. Jørgensen , Rikke Sørensen , Steen Z. Abildstrøm , Peter Riis Hansen , Jan Kyst Madsen , Lars Køber , Christian Torp-Pedersen , and Gunnar Gislason Metrics Cited ByStress-related mucosal disease in the critically ill patientImpacto de las alertas farmacoterapéuticas sobre la prescripción de clopidogrel e inhibidores de la bomba de protones en pacientes ingresados 21 September 2010Volume 153, Issue 6Page: 413-415KeywordsDrug interactionsHemorrhageMyocardial infarctionObservational studiesRisk managementStatins ePublished: 21 September 2010 Issue Published: 21 September 2010 CopyrightCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...