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In Reply: We agree with Drs Chae and Kim that some PPIs may not be associated with attenuation of the benefits of clopidogrel. In our study, the majority of patients were prescribed omeprazole and, to a smaller extent, rabeprazole. Thus, the results are primarily referable to these agents.

Chae and Kim cite the ACCF/ACG/AHA consensus statement on reducing gastrointestinal risks of antiplatelet therapy and NSAID use. This statement recommended that patients taking dual antiplatelet therapy should be prescribed a PPI medication in the presence of specific risk factors.¹

In response to their request to compare PPI users and nonusers, we performed additional analyses among patients discharged on clopidogrel and prescribed a PPI medication at discharge or during follow-up. Periods of PPI-only use compared with no medication use (ie, neither PPI nor clopidogrel) were not associated with adverse outcomes (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.82-1.24). Periods of clopidogrel-only . . . [Full Text of this Article]

P. Michael Ho, MD, PhD
michael.ho@va.gov

John S. Rumsfeld, MD, PhD
Denver VA Medical Center
Denver, Colorado

Li Wang, MS
Puget Sound Health Care System
Seattle, Washington

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