Laila Shalabi: Clopidogrel, Aspirin, and the Role of PPIs in Coronary Artery Disease
Laila Shalabi, Medical Student at Gharyan Central Hospital, Libya, shared a post on LinkedIn about a recent article she and her colleagues co-authored, adding:
“Adding a voice to an ongoing clinical debate. While recent meta-analyses favor clopidogrel over aspirin, the nuances of concomitant medications specifically Proton Pump Inhibitors (PPIs) cannot be ignored.
In our Lancet correspondence, we highlighted that while clopidogrel is superior to aspirin, concurrent PPI use significantly attenuates its bleeding and efficacy benefits, making a patient’s medication list a primary determinant of clinical success. We specifically recommended pantoprazole for its better pharmacodynamic profile and called for more targeted research. The authors replied by acknowledging that while PPIs might modify bleeding risk, clopidogrel’s ischemic benefits remain consistent and superior regardless of PPI use.
They further cautioned against overinterpreting subgroup trends where no significant treatment-by-subgroup interaction was observed for cardiovascular outcomes. This dialogue underscores the clinical complexity of antiplatelet therapy in the secondary prevention phase.
I am deeply grateful to my colleague Ahmed Ibrahim for the true teamwork, and to our mentor Prof.Andò for his continuous support and guidance.”
Title: Clopidogrel versus aspirin for coronary artery disease
Authors: Ahmed Ibrahim, Laila Shalabi, Giuseppe Andó
Read the Full Article on The Lancet.
Title: Clopidogrel versus aspirin for coronary artery disease – Authors’ reply
Authors: Marco Valgimiglia, Felice Gragnano, Daniele Giacoppo
Read the Author’s Reply on The Lancet.
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