Letter by Zheng et al Regarding Article, “Cerebrovascular Outcomes With Proton Pump Inhibitors and Thienopyridines: A Systematic Review and Meta-Analysis”
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To the Editor:
We read with great interest the article by Malhotra et al1 in the recent issue of Stroke. The authors investigated the association of concomitant use of proton pump inhibitors (PPIs) and thienopyridines with cerebrovascular outcomes. They concluded that a coprescription of PPIs and thienopyridines increases the risk of ischemic stroke, stroke, and composite outcome of stroke, myocardial infarction, and cardiovascular death. We have several concerns about the study.
First, previous studies suggested that different PPIs exhibit different degrees of inhibitory effect on CYP2C19.2,3 A study showed that patients administered pantoprazole did not show any significant changes in CYP2C19 activity and platelet reactivity, which is different from the results reported for omeprazole and esomeprazole. …