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Conflicting Evidence: What's a Clinician to Do?

Joao Paulo de Aquino Lima; and James M. Brophy, MD, PhD
[+] Article, Author, and Disclosure Information

From Federal University of Ceará School of Medicine, Fortaleza, Brazil; and McGill University, Montreal, Quebec H3A 1A1, Canada.

Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1709.

Requests for Single Reprints: James M. Brophy, MD, PhD, Royal Victoria Hospital, 687 Pine Avenue West, R4.12, Montreal, Quebec H3A 1A1, Canada; e-mail, james.brophy@mcgill.ca.

Current Author Addresses: Mr. de Aquino Lima: 650 Visconde de Maua Street, Fortaleza, Ceará, 60125-160, Brazil.

Dr. Brophy: Royal Victoria Hospital, 687 Pine Avenue West, R4.12, Montreal, Quebec H3A 1A1, Canada.

Ann Intern Med. 2010;153(6):413-415. doi:10.7326/0003-4819-153-6-201009210-00011
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In this issue, Charlot and colleagues (1) use Danish national administrative databases to analyze the association between cardiovascular death, myocardial infarction, or stroke and the concomitant use of proton-pump inhibitors (PPIs) and clopidogrel in patients who have had a myocardial infarction. They report no evidence for a specific drug interaction and find that PPIs were associated with an increased risk for adverse cardiovascular outcomes independent of clopidogrel use. As summarized by Charlot and colleagues, several other studies (26) have been published on this subject, and—despite conflicting results—regulatory bodies have issued edicts (78) that warn about a clinically significant drug interaction. How, then, should clinicians interpret this conflicting body of evidence? We propose that a critical systematic review of all of the evidence would certainly help, but that a meta-analysis that combines studies of very uneven scientific quality would not.

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