A recent, albeit retrospective, study suggests a correlation.
MedPage Today reports on a recent JAMA study that looked at patients who had an acute coronary syndrome. It found that those who took both a proton pump inhibitor (PPI), like omeprazole, Nexium or Protonix, with Plavix had a 25 percent increased risk of death or rehospitalization.
If true, that’s a pretty significant finding, especially since PPIs are being reflexively prescribed to more patients, especially those who are hospitalized and report symptoms consistent with esophageal reflux.
What’s the cause? Apparently, “both drugs share common metabolic pathways mediated by . . . the liver. Supporting this explanation, both translational and clinical studies have demonstrated that PPIs reduce the antiplatelet effects of clopidogrel.”
A more interesting hypothesis is that those on PPIs are simply sicker, thus, “patients taking both drugs are simply at higher risk.”
Not sure if that latter reason holds water.
Like all retrospective studies, it needs to be corroborated by prospective, double-blind studies, but the results should give pause to doctors thinking of starting PPIs in the context of treating acute coronary syndrome patients with Plavix.
Related posts:
- Is the flu a heart attack risk factor?
- ER crowding and your risk of dying from a heart attack
- Can aspirin with Plavix be a new option to prevent stroke in atrial fibrillation?
- Lawyers scaring patients off Plavix
- Do heart attack patients benefit from an implantable cardioverter defibrillator (ICD)?
- Don’t have a heart attack on the weekends
- New troponin tests to better diagnose a heart attack
{ 2 comments }
Another case where an individualized approach using best evidence is necessary… if a patient has a history of GI bleed their risk of recurrent GI bleed on Plavix is probably great than the 24% increased risk of death or rehospitalization. This is especially true given that the 25% difference in that composite outcome was driven almost entirely by rehospitalization for acute coronary syndrome, especially unstable angina (i.e. not heart attacks or MI). If that doesn’t have other risk factors for GI bleed though (history of ulcer for example) it looks like “prophylactic” PPI therapy may cause more harm than benefit. Primum non nocere.
Or how about not taking Plavix at all? What’s your risk of an MI then? While the effects of Plavix might be diminished somewhat, I’ll take little effect over nothing at all.
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