In the COGENT (Clopidogrel and the Optimization of Gas- trointestinal Events) study,42 omeprazole was compared with placebo in 3627 patients starting dual antiplatelet therapy with aspirin and clopidogrel. No difference was found in the primary composite cardiovascular endpoint between clopi- dogrel plus omeprazole and clopidogrel plus placebo (HR: 1.02), but GI bleeding complications were reduced.42 CO- GENT had several shortcomings (see Online Data Supple- ment), and more controlled, randomized clinical trial data are needed to address the clinical impact of conjunctive therapy with clopidogrel and PPIs. The FDA communication on an ongoing safety review of clopidogrel bisulfate14 advises that healthcare providers should reevaluate the need for starting or continuing treatment with a PPI, including omeprazole, in patients taking clopidogrel. The FDA notes there is no evidence that other drugs that reduce stomach acid, such as H2 blockers or antacids, interfere with the antiplatelet activity of clopidogrel. Healthcare providers should continue to prescribe and patients should continue to take clopidogrel as directed, because clopidogrel has demonstrated benefits in preventing blood clots that could lead to a heart attack or stroke. Healthcare providers should reevaluate the need for starting or continuing treatment with a PPI, including omepra- zole (over the counter), in patients taking clopidogrel. Patients taking clopidogrel should consult their healthcare provider if they are currently taking or considering taking a PPI, including omeprazole.14 The ACCF has released a statement on the use of PPI agents in combination with clopidogrel. The expert consen- sus statement does not prohibit the use of PPI agents in appropriate clinical settings, yet highlights the potential risks and benefits from use of PPI agents in combination with 3.2.3.1.6. Glycoprotein IIb/IIIa Receptor Antagonists. 