Heart patients who took a stomach acid-suppressing proton-pump inhibitor along with clopidogrel—a drug that prevents blood clots—were only half as likely to be hospitalized for upper digestive tract bleeding than those who used clopidogrel alone, according to a new study. The study also suggested that combining the drugs did not increase the risk of serious heart problems. Clopidogrel (sold as Plavix®, Clopilet®, and Ceruvin®), a blood thinner, is usually prescribed for heart patients to reduce the risk of a heart attack or stroke and can also cause bleeding stomach ulcers. Proton-pump inhibitors, which include pantoprazole (Protonix®), omeprazole (Prilosec®), lansoprazole (Prevacid®), esomeprazole (Nexium®) and rabeprazole (Aciphex®), are used to prevent or treat ulcers, acid reflux disease, and other stomach acid-related problems.
Although proton-pump inhibitors are commonly prescribed with clopidogrel to reduce the risk of upper digestive tract bleeding, clinicians worry that this practice may decrease the drug's ability to prevent blood clots. Yet this study found that concurrent use of a proton-pump inhibitor and clopidogrel did not increase patients' risk of heart attack, sudden cardiac death, stroke, or other cardiovascular problems. However, the researchers at the Center for Education and Research on Therapeutics (CERT) at the Vanderbilt University Medical Center noted that even though they did not find an elevated cardiovascular risk from this drug combination, they cannot rule it out and call for more studies.
Their findings were based on data from nearly 21,000 patients in the Tennessee Medicaid program between 1999 and 2005. The researchers divided the patients into two groups—those who were prescribed clopidogrel by itself and those who took clopidogrel in combination with a proton-pump inhibitor. They then determined how many patients in each group had been hospitalized for gastrodoudenal ulcers—raw tissue in the upper part of the small intestine, or duodendum, where it connects to the stomach. The study was supported in part by a grant from the Agency for Healthcare Research and Quality to the Vanderbilt Medical Center CERT.
For more details, see "Outcomes with concurrent use of clopidogrel and proton-pump inhibitors," by Wayne A. Ray, Ph.D., Katherine T. Murray, M.D., Marie R. Griffin, M.D., M.P.H., and others, in the March 16, 2010, Annals of Internal Medicine 152, pp. 337-345.
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