Proton Pumpers Prevent Plavix Perks II

March 25th, 2009 | Sources: JAMA, MedPageToday

Subjects:

That story about heartburn drugs like Nexium, Prilosec and other proton-pump inhibitors interfering with the cardio-protective effects of Plavix is growing legs.

plavixBefore Thanksgiving, Medco Health Solutions presented the results of a retrospective study of Plavix following stent placement and angioplasty.

In the study, patients taking PPIs and Plavix sustained 50% more heart attacks and other cardiac events than those just taking Plavix.

Now, Michael Ho and colleagues from the Denver VA are reporting that acute coronary syndrome patients who received both drugs had a 25% higher risk of death or readmission for the same syndrome as those receiving Plavix alone.

64% of the patients in Ho’s study were discharged on both drugs. 

Ho’s study was also retrospective. It appears in JAMA.

The authors concluded that PPIs should only be prescribed for Plavix-popping patients who have a “a clear indication for the medication” rather than using them prophylacticly, as has become common.

There are theories to explain the association. One fingers common metabolic pathways in the liver. Another proposes that the PPIs directly interfere with Plavix’ antiplatelet effects.

But it’s also possible that PPI use is nothing but a marker for sick patients who are more likely to have a lousy outcome anyway.

Issam Moussa of Weill Medical College at Cornell observed in fact that the patients who received PPIs in Ho’s study “were older, and had more comorbidities than patients who didn’t.”

The controversy moved the Brigham’s Chris Cannon to review data from his prospective CREDO study, which showed Plavix to be useful following coronary stenting.

wtfCannon’s review turned up “no evidence of increased risk for (the combo),” so now the whole thing is a mess.

Plavix is co-marketed by Sanofi-Aventis and Bristol-Meyers Squibb.

It did $4 plus billion in sales last year.

AZ’s Nexium came in at $5.5 billion.


 

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