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| |  PPIs Thwart Clopidogrel’s Anticlotting Effectiveness in Diabetics Post Stenting: Presented at ADA By Jill Stein NEW ORLEANS -- June 7, 2009 -- Proton pump inhibitors (PPIs) interfere with clopidogrel’s effectiveness in preventing repeat cardiovascular events in patients with diabetes who have undergone percutaneous coronary intervention (PCI) with stenting, researchers said here on June 6 at the American Diabetes Association (ADA) 69th Scientific Sessions. Ron Aubert, Clinical Analysis and Outcomes Research, Medco Health Solutions, Franklin Lakes, New Jersey, and colleagues examined outcomes in 4,005 patients with diabetes who had undergone PCI and stenting. Overall, 2,238 patients had received clopidogrel alone and 1,767 had received clopidogrel with a PPI. The analysis comes in the wake of the Clopidogrel Medical Outcomes trial that reviewed outcomes in 16,690 patients who received clopidogrel post-stenting. Results showed that the risk of major adverse cardiovascular events was significantly higher in patients taking a PPI compared with patients who did not (25.1% vs 17.9%; P < .0001). In the present study, the primary endpoint was the 12-month incidence of the composite of hospitalisation for myocardial infarction (MI), unstable angina, stroke/transient ischaemic attack, PCI/coronary artery bypass graft, or cardiovascular death (resuscitated and resulting in hospitalisation). PPIs included omeprazole, lansoprazole, esomeprazole, pantoprazole, and rabeprazole. The primary endpoint rate was 19.7% in patients not taking a PPI and 26.7% in patients taking clopidogrel and PPI therapy (hazard ratio 1.44, P < .0001). Dr. Aubert said that the findings suggest a clinically significant drug interaction between PPIs and clopidogrel resulting in a higher incidence of major adverse cardiac events within 1 year after coronary stenting in patients with diabetes. He commented that the results provide additional support for recent recommendations discouraging the use of PPIs with clopidogrel. He also urged that doctors consider therapeutic alternatives to PPIs for gastrointestinal symptoms in patients with stents when they are not clearly or strongly indicated. Funding for this study was provided by Medco Health Solutions, Inc. [Presentation Title: Proton Pump Inhibitors Diminish Effectiveness of Clopidogrel After Coronary Stenting in Patients With Diabetes. Abstract 1034-P]
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