Medrants' point is that they didn't compare Plavix + Nexium and that it is a no-brainer that Plavix can cause ulcers. These ulcers would then be prone to bleed, as Plavix is an anti-platelet agent.
Well, yeah, but I interpreted the point of the study differently. The point, as I can tell, was to show that an expensive drug was not better, and, in fact, was worse, than a cheap drug plus a middle cost drug. Plavix is more expensive that ASA+Nexium and yet is no better. Why study Plavix+PPI when it would be so much more expensive?
One of the main reasons I see Plavix prescribed is for patients who have an "aspirin sensitive" stomach. Well, if adding a PPI is cheaper and better than switching to Plavix, why not do this instead?