There is ongoing controversy of how clinically significant it is that PPIs reduce the anti-platelet effect of clopidogrel. In this case-control of patients who had a stroke / TIA and who were started on clopidogrel, those who were also on a PPI did not have an increased risk of subsequent stroke or death, compared to those not on a PPI. Similar to the recommendations for patients on clopidogrel for cardiovascular protection, those on clopidogrel for cerebrovascular protection who also require a PPI should probably be on pantoprazole (instead of omeprazole or esomeprazole) (abstract)
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