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May 6, 2009 -- 4:05pm EDT

Plavix PPI Study Released
Back in January, I discussed the latest, and somewhat confusing information about whether or not the use of Proton Pump Inhibitors (PPI) interfered with the effectiveness of antiplatelet drugs like Plavix (clopidogrel) -- an extremely important medication for stent patients. Plavix can lead occasionally to bleeding complications and may cause stomach upset. A relatively new class of drugs, including Nexium, Prilosec, Prevacid and Protonix, were supposed to be very effective in countering stomach upset and possibly gastrointestinal bleeding.

But a study released today at the SCAI annual meeting showed a greater than 50% increase in major adverse cardiac events in stent patients who were taking both clopidogrel and a PPI.

The message was that PPIs have probably been over-prescribed for this particular patient population. The recommendation to patients was to consult their cardiologists, and not unilaterally change their drug regimen (and specifically not to stop taking Plavix -- early cessation of clopidogrel carries an increased risk of stent thrombosis which can lead to heart attack or death). The recommendation to physicians was to look more carefully at why each individual patient might or might not benefit from a PPI, but probably not to give it prophylactically -- and also to return to an earlier class of drugs, called histaminergic (H2) blockers (Zantac, Tagamet) or even common antacids.

Of course, a reader of an earlier posting on this blog, D.B. who is a pharmacist in California, already figured this out for himself.

Oddly enough, the incidence of gastrointestinal bleeding that required hospitalization was very low across the board, but numerically lower in patients who were not taking PPIs.

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