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| |  Effectiveness of Clopidogrel May Be Reduced by Common Heartburn Drugs: Presented at SCAI By Carole VanSickle Ellis LAS VEGAS -- May 10, 2009 -- The concomitant use of clopidogrel and 4 commonly prescribed proton pump inhibitors (PPIs) can cause a 51% increase in risk of major adverse cardiovascular events (MACE), researchers stated here at the 32nd Annual Scientific Sessions of the Society for Cardiovascular Angiography and Interventions (SCAI). Researchers stated in a late-breaking abstract presentation on May 6 that the reason for the effect may be because the PPIs interfere with the metabolic processes of the liver enzymes that activate the clopidogrel. It should be noted that SCAI has released an official statement about the report, saying that more research is needed on the topic. Lead author and presenter Eric J. Stanek, Medco Health Solutions, Inc., Franklin Lakes, New Jersey, reiterated that sentiment saying that if a patient is taking clopidogrel in conjunction with a PPI, then the issue “needs attention, but is not a medical emergency.” In fact, abrupt discontinuation of clopidogrel is extremely like to cause cardiovascular problems. The study used data from patients taking clopidogrel obtained from the Medco databases of 60 million Americans from across the United States to determine the risk of hospitalisation with complications with cardiovascular stents from concomitant use of PPIs and clopidogrel. Researchers addressed omeprazole, esomeprazole, pantoprazole, and lansoprazole, as these 4 PPIs make up 96% of all prescribed PPIs in the United States. The patients were selected from 41,063 patients in the Medco database that had received a coronary stent and began taking clopidogrel within 1 month. These patients had to show good clopidogrel adherence and never have taken the drug prior to coronary stenting. Ultimately, 16,690 patients qualified, with 9,862 taking a PPI and 6,828 not taking a PPI. The overlap of the clopidogrel and PPI was, at a minimum, 293 days. During this time, patient records were used to track hospitalisation and to analyse the baseline health of the patients. Clopidogrel dosage was 75 mg per day in 99.5% of the patients. None of the patients had prior gastrointestinal (GI) bleeding. MACE was determined to include myocardial infarction (MI), stroke, unstable angina, stroke symptoms, repeat coronary procedures, and coronary death. Patients taking PPIs and clopidogrel had a 25% risk of MACE, while patients not taking a PPI had a lower risk level of 17.9%. No fatalities were observed in the study, though there were complications, as was expected. Prior exposure to a PPI before coronary stenting appeared to slightly increase the risk for hospitalisation. The researchers noted that more trials are needed to determine how genetic liver variations could change or impact the results of clopidogrel adherence and PPI influence on this, as well as pointing out that a change in the dosing time frame might alter the findings. Funding for this study was provided by Medco Health Solutions. [Presentation title: A National Study of the Effect of Individual Proton Pump Inhibitors on Cardiovascular Outcomes in Patients Treated With Clopidogrel Following Coronary Stenting: The Clopidogrel Medco Outcomes Study. Abstract O-11]
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