Protonpompremmers bij gebruik van clopidogrel

Afweging tussen noodzaak en nadelen
Dilemma
13-06-2019
Kim van der Elst, Berdien Oortgiesen, Willemien Kruik-Kollöffel, Mels Hoogendoorn, Sjoerd Hofma en Eric van Roon

Proton pump inhibitors when using clopidogrel: balance between necessity and disadvantages

Rationale

When patients are using carbasalate calcium or acetylsalicylic acid (ASA), it is recommended to prescribe a proton pump inhibitor (PPI) in order to prevent gastrointestinal (GI) bleeding. Should this recommendation also be followed for patients who are using clopidogrel in monotherapy, which is increasingly the case in practice?

Method

In a systematic literature review of the occurrence of GI bleeding when using clopidogrel versus ASA, we included 9 studies that compared the risk of GI bleeding when using ASA with clopidogrel monotherapy.

Results

These 9 studies on clopidogrel and ASA show that the risk of GI bleeding is also elevated when using clopidogrel monotherapy and that it is comparable with the risk of GI bleeding when using ASA.

Conclusion

Based on the current literature, we recommend prescribing pantoprazole to patients who are using clopidogrel monotherapy and have additional risk factors for GI bleeding, in accordance with the procedure for low-dose ASA. The risk of GI bleeding must be weighed against the disadvantages of using PPIs.

Conflict of interest and financial support: none declared.