Figure 4 Activation of clopidogrel via cytochrome P450

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Forest plot of studies examining outcomes between patients taking proton pump inhibitor (PPIs) with clopidogrel and those taking only clopidogrel: (A)

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Figure 4 Activation of clopidogrel via cytochrome P450 Figure 4 | Activation of clopidogrel via cytochrome P450. a | Normal activation of clopidogrel occursvia CYP2C19. b | Loss-of-function mutation of CYP2C19 leads to reduced activation of clopidogrel. c | A possible reduced activation of clopidogrel has been suggested in patients on proton-pump inhibitor (PPI) therapy (particularly for omeprazole) due to competition for the same pathway. Malfertheiner, P. et al. (2017) Proton-pump inhibitors: understanding the complications and risks Nat. Rev. Gastroenterol. Hepatol. doi:10.1038/nrgastro.2017.117