http://www.kevinmd.com/blog/2009/03/does-using-plavix-with-proton-pump.html Tue, 14 Feb 2012 19:56:00 +0000 hourly 1 http://www.kevinmd.com/blog/2009/03/does-using-plavix-with-proton-pump.html#comment-90170 halfmd Mon, 09 Mar 2009 20:06:00 +0000 http://clients.emmense.com/kevinmd/2009/03/does-using-plavix-with-a-proton-pump-inhibitor-raise-the-risk-of-death-in-heart-attack-patients.html#comment-90170 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. 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.

]]> http://www.kevinmd.com/blog/2009/03/does-using-plavix-with-proton-pump.html#comment-90086 roger Thu, 05 Mar 2009 02:12:00 +0000 http://clients.emmense.com/kevinmd/2009/03/does-using-plavix-with-a-proton-pump-inhibitor-raise-the-risk-of-death-in-heart-attack-patients.html#comment-90086 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. 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.

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