Level 2: Mid-level evidence

Earlier this year, two retrospective studies linked the combined use of proton-pump inhibitors (PPIs) and clopidogrel (Plavix) with increased adverse cardiovascular events in patients who had acute coronary syndrome or MI. Now a newer study has presented conflicting evidence based on analyses comparing outcomes in patients taking PPIs vs. those not taking PPIs in two trials evaluating clopidogrel vs. prasugrel (Lancet. 2009; 374:989-997). No significant differences were in the composite outcomes of cardiovascular death, MI, and stroke were associated with PPI use in patients taking clopidogrel.