Does using Plavix with a proton pump inhibitor raise the risk of death in heart attack patients?

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.

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