WEDNESDAY, Oct. 6 (HealthDay News) -- Heartburn drugs known as
proton-pump inhibitors can safely be taken with the blood thinner
Plavix, a new study indicates.
There has been concern that these medications, called PPIs,
might interfere with the ability of Plavix (clopidogrel) to do its
"This is reassuring data that there is not any clinically significant interaction between clopidogrel and PPIs," said lead researcher Dr. Deepak L. Bhatt, chief of cardiology at the Veterans Affairs Boston Healthcare System.
"This is contrary to prior observational, non-randomized studies that showed that if you took clopidogrel and a PPI, it blunted the ability of clopidogrel to protect from things like heart attack," he noted.
In addition, this is the first randomized clinical trial to show
that prophylactic use of PPIs for patients taking Plavix reduces
gastrointestinal bleeding, he said.
Doctors often prescribe the two drugs in combination to prevent
clotting and reduce the risk of stomach bleeding, which can be a
serious complication for patients taking Plavix.
Randomized, double-blind trials that compare outcomes of
patients taking a drug or placebo, or another drug are considered
the "gold standard" of clinical trials, because they can actually
show what patients experience.
In contrast, observational studies use data from patient records
or other sources to paint a picture of patient outcomes. Since
these data are from past experience, the conclusions of these
studies can find associations, but not establish causes of
The report is published in the Oct. 6 online edition of the
New England Journal of Medicine.
For the study, Bhatt and colleagues randomly assigned 3,873
patients who needed Plavix to Plavix alone or in combination with
omeprazole (Prilosec) or a placebo; patients also received
Over six months, 51 patients had gastrointestinal bleeding. That
was a rate of bleeding of 1.1 percent among those taking Plavix
plus Prilosec and 2.9 percent among those taking Plavix and a
placebo, the researchers found.
In addition, 109 patients had a heart attack, stroke, died or
needed another cardiac procedure. The rate of these events was 4.9
percent among those receiving Prilosec and 5.7 percent among those
receiving a placebo, Bhatt's group found.
More patients taking Prilosec had a higher risk of diarrhea, the
The study also had two main limitations, the researchers
reported: It was terminated early due when the sponsor, Cogentus
Pharmaceuticals, lost financing, and the numbers of participants
were not large enough to rule out the possibility of a clinically
significant difference in cardiovascular events, such as heart
attack, due to the use of a PPI.
However, the study did not find any significant increases in the
risk of cardiovascular events, even in high-risk group, the
"This should be quite reassuring to physicians that there isn't a bad interaction to worry about," Bhatt said.
Commenting on the study, Dr. Gregg Fonarow, a professor of
cardiology at the University of California, Los Angeles, said that
"there have been significant concerns based on observational
studies and platelet function testing that proton-pump inhibitors
like Prilosec may interfere with the antiplatelet effect of
clopidogrel, increasing the risk patients would have cardiovascular
"This trial is quite reassuring, with no signal of cardiovascular harm when proton pump inhibitors are given to patients receiving clopidogrel and aspirin," said Fonarow, who was not involved with the study. "Prophylactic use of proton-pump inhibitors may be appropriate in patients at increased risk for gastrointestinal bleeding."
Another expert, Dr. James Brophy, a professor of medicine and
epidemiology at the Royal Victoria Hospital in Montreal, said that
"much of the problem of earlier research in this area has been
observational and therefore subject to potential biases. The
present study is a big step forward as it was a randomized
This latest finding -- coupled with the fact that other recent
studies have not confirmed earlier studies suggesting an increased
in adverse cardiac events -- is reassuring, he said.
"For the moment, the data is reassuring that PPIs can be safely prescribed if there is a clinical indication," Brophy said. "The story does seem a prime example of the Proteus phenomena, initially very positive worrisome results generally being proven to be not as extreme as initially feared."
Indeed, a recent Danish study also found that taking Plavix and
a PPI together was safe and did not compromise the effects of
For more information on the Plavix-PPI combo, visit the
U.S. Food and Drug Administration.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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