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Both omeprazole and esomeprazole inhibit CYP2C19, leading to: Reduced formation of active clopidogrel metabolite Decreased antiplatelet efficacy Increased risk of thrombotic events (MI, stroke, stent thrombosis) Clinical takeaway: When gastric protection is required in patients on clopidogrel, consider safer alternatives such as: Pantoprazole Rabeprazole This simple switch can significantly improve therapeutic outcomes and patient safety

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