Final answer:
The two PPIs to avoid with clopidogrel are omeprazole and esomeprazole, as they can reduce the drug's effectiveness in preventing cardiovascular events by inhibiting its activation.
Step-by-step explanation:
The two proton pump inhibitors (PPIs) that must be avoided with clopidogrel are omeprazole and esomeprazole. These PPIs can inhibit the enzyme CYP2C19, which is crucial for the activation of clopidogrel. Without adequate activation, clopidogrel's effectiveness as an anti-platelet therapy is reduced, potentially leading to a higher risk of cardiovascular events.
While clopidogrel plus aspirin—a form of dual anti-platelet therapy—has been shown to reduce cardiovascular events more than aspirin alone following a STEMI, the evidence is weak for its use in high-risk patients who have not had an acute event. Additionally, extending the duration of clopidogrel plus aspirin therapy beyond 12 months for those who've had a stent does not appear to affect the risk of death.