, Volume 6, Issue 2, pp 159-160
Date: 03 Mar 2011

The prophylactic use of a proton pump inhibitor (PPI) in patients treated with clopidogrel and aspirin for an acute coronary syndrome or placement of a coronary stent reduces the rate of upper gastrointestinal bleeding with no apparent increase in cardiovascular events

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Background

In recent years, more and more patients have been treated with dual antiplatelet therapy (clopidogrel and aspirin), mainly for acute coronary syndrome or after the placement of a coronary stent [1]. While this therapy is efficacious in reducing cardiovascular events, there are some worries about its safety, in particular regarding the risk of upper gastrointestinal haemorrhage. In this regard, proton pump inhibitors (PPI)s reduce the risk of bleeding in patients treated with low dose aspirin or non-steroidal antinflammatory drugs (NSAIDs), and might be an attractive way to improve the safety of dual antiplatelet therapy [2]. Biological studies have shown a broad inter-individual variability of platelet response to clopidogrel, and more recently, a low response to clopidogrel has been associated with an increased risk of ischemic events [3]. Several mechanisms have been proposed to explain this variability of response, including genetic factors and interaction with other medic

Simona Sada and Giorgio Costantino on behalf of GrAM.