Friday, September 25, 2009

PPIs blunt effect of clopidogrel-yes they do,no they don't

Patients and physicians alike had to be a bit worried when this study suggested that PPIs decrease the efficacy of clopidogrel and could lead to more cardiovascular events. But the story continues and the results of the COGENT study discussed here said "no" : presumably offering some reassurance that the putative PPI inhibition of the desired beneficial pharmacological effect of clopidogrel is not really a problem.

What if the articles were published in reverse order?

Does the fact that COGENT was a randomized trial with placebo versus omeprazole in patients on clopidogrel and the Medco data study was more of a data dredge mean that we have no need to worry? Or does the fact that the COGENT trial was stopped ( the sponsor,Cogentus, filed for bankruptcy) before the planned number of patients were enrolled limit the power of the trial to find a real difference mean that we should question how much we should really be reassured? Can anyone tell me if the prematurely stopped COGENT trial was adequately powered to show a difference as great as that reported in the Medco study?

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