Letter by Pacheco et al Regarding Article, “Proton Pump Inhibitors, Platelet Reactivity, and Cardiovascular Outcomes After Drug-Eluting Stents in Clopidogrel-Treated Patients: The ADAPT-DES Study”

In a predefined subanalysis of the Assessment of Dual Antiplatelet Therapy With Drug Eluting Stents (ADAPT-DES) study, Weisz et al1 found an association between co-prescription of clopidogrel and proton pump inhibitors (PPIs) and higher rates of major adverse cardiac events. Similar to prior studies,2 increased platelet reactivity on PPI therapy was demonstrated.1 However, although increased platelet reactivity was associated with a higher incidence of stent thrombosis (ST),3 PPI use was not associated with a statistically significant increase in either ST or myocardial infarction after adjustment.1Rather, the difference in major adverse cardiac event observed in ADAPT-DES seems to have been primarily driven by revascularization, …