(Ivanhoe Newswire) – Doctors often prescribe the antiplatelet drug
clopidogrel along with aspirin to people who suffer a heart attack or unstable
angina. The goal is to keep the blood flowing freely and ward off another
attack.
But clopidogrel is known to cause gastrointestinal bleeding, so many times these
patients also receive a prescription for a type of heartburn drug called a
proton pump inhibitor (PPI) to lessen the chance of stomach upset.
New research out of the Denver VA Medical Center suggests that may be akin to
throwing the baby out with the bathwater. In a review of more than 8,000
patients prescribed clopidogrel following hospital discharge for a heart
problem, investigators found a significantly higher rate of death and
rehospitalization in those who also received a PPI.
Overall, nearly 64 percent of the patients received prescriptions for both
drugs, and among that group, nearly 30 percent died or had to go back into the
hospital for a heart condition. This compares to just under 21 percent for
people who did not receive a PPI. The difference translates to about a 25
percent increased risk of death or rehospitalization for patients on both of the
medications.
The authors note no increase in death or complications was seen among other
patients who left the hospital with only a PPI prescription, suggesting an
adverse interaction between clopidogrel and PPIs is causing these effects.
“While the risk estimates associated with clopidogrel plus PPI vs. clopidogrel
without PPI were modest, the absolute number of adverse events attributable to
this potential drug interaction is considerable when extrapolated to a
population level, given how frequently PPI medications are prescribed to
patients receiving dual-antiplatelet therapy,” write the authors.
Until the issue is better understood, they suggest doctors consider prescribing
a PPI only for those heart patients with a history of gastrointestinal tract
bleeding or other problems the drugs are intended to treat.
SOURCE: The Journal of the American Medical Association, published online March
3, 2009
