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"Adjunctive use of PPIs for the duration of dual antiplatelet therapy does not increase the rates of all-cause death, rehospitalization for ACS, stent thrombosis, or the combination of all three in patients after stent implantation," Tentzeris concluded.
But in response to Angiolillo's rebuff, Tentzeris clarified to his audience that 75% of the patients in the study had received pantoprazole (Protonix, Wyeth), which "doesn't inhibit cytochrome p450, and it may be that in patients who need a PPI, pantoprazole can be administered," he said. Previous research has suggested that patients treated with pantoprazole had a significantly better platelet response to clopidogrel than those treated with omeprazole. Moreover, Tentzeris noted, while stent-thrombosis numbers were higher in PPI-treated patients, mortality rates were not increased in this group.
...As to the argument that some patients taking clopidogrel do need gastroprotection, Angiolillo conceded that it might be okay to "go with pantoprazole, which does not interfere with 2C19 or has minimal interference, or use an H2 receptor blocker."
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CONSENSUS!?!
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