Q: 48 year old male is going for coronary stents placement after non-ST MI. Patient has previous history of severe GERD which is responsive only to Omeprazole (proton-pumo inhibitor). Which anti-platelet would be recommended?

Answer: Prasugrel

Clopidogrel (plavix) is the most commonly used anti-platelet agent along with aspirin in patients requiring coronary stents. But, clopidogrel has shown to have decreased effect in patients using proton pump inhibitors (PPI)  particularly omeprazole or esomeprazole (pantoprazole appears to be relatively safe).

Prasugrel has minimal interaction with PPIs, hence considered to be better choice in patients who are on PPIs and require coronary stents.