Increased death risk linked to
combined use of antiplatelet, gastic acid meds after heart
attack of angina.
March 3, 2009 - Following a heart attack, unstable
angina or other acute coronary syndrome, patients who receive a
medication to reduce the risk of gastrointestinal bleeding that may be
associated with the use of the antiplatelet drug Plavix and aspirin
have an increased risk of subsequent hospitalization for acute coronary
syndrome or death, according to a study in the March 4 issue of the
Journal of the American Medical Association (JAMA).
Plavix, from Sanofi-Aventis and Bristol-Myers Squibb, is also known by its
generic name, clopidogrel.
Treatment with clopidogrel in addition to aspirin
reduces recurrent cardiovascular events following hospitalization for
acute coronary syndrome (ACS) for patients treated either medically or
with angioplasty or stent placement.
One of first studies to focus on senior citizens and
ICDs finds older people are good candidates for ICDs to prevent death
from arrhythmias; but benefit diminishes when age combined with multiple
disease conditions
FDA has drug in priority review; approves first
ablation catheters for the treatment of atrial fibrillation, which
affects mainly senior citizens over age 65
Proton pump inhibitor (PPI) medications are often
prescribed at the start of treatment with clopidogrel, with the goal of
reducing the risk of gastrointestinal tract bleeding while patients are
taking dual-antiplatelet therapy. Recent studies, however, suggest that
PPIs may reduce the effectiveness of clopidogrel, but the clinical
significance of these findings to patients is not clear, according to
background information in the article.
P. Michael Ho, M.D., Ph.D., of the Denver VA
Medical Center, and colleagues evaluated the use of clopidogrel plus PPI
following hospital discharge for ACS and compared rates of all-cause
death and rehospitalization for ACS, between patients taking clopidogrel
plus PPI vs. clopidogrel without PPI. The study included patients from
127 Veterans Affairs hospitals. Vital status information was available
for all patients through September 30, 2006.
Of 8,205 patients with ACS taking clopidogrel after
hospital discharge, 63.9 percent (n = 5,244) were prescribed PPI at
discharge or during follow-up. Death or rehospitalization for ACS
occurred in 29.8 percent of patients prescribed clopidogrel plus PPI and
20.8 percent of patients prescribed clopidogrel without PPI . Use of
clopidogrel plus PPI at any point in time was associated with a 25
percent increased odds of death or rehospitalization for ACS compared
with use of clopidogrel without PPI.
For the individual outcomes, the rates of recurrent
hospitalization for ACS (14.6 percent vs. 6.9 percent) and
revascularization procedures (15.5 percent vs. 11.9 percent) were higher
among patients taking clopidogrel plus PPI compared with those taking
clopidogrel without PPI. However, the risk of death was similar between
the two groups.
"When patients were not taking clopidogrel after
hospital discharge, a prescription for PPI was not associated with death
or rehospitalization for ACS, supporting the hypothesis that the
interaction of PPI and clopidogrel, rather than PPI itself, was
associated with increased adverse outcomes," the authors write.
"...this study raises some concern about
concomitant (accompanying) use of PPI medications and clopidogrel
following hospitalization for ACS.
While the risk estimates associated with
clopidogrel plus PPI vs. clopidogrel without PPI were modest, the
absolute number of adverse events attributable to this potential drug
interaction is considerable when extrapolated to a population level,
given how frequently PPI medications are prescribed to patients
receiving dual-antiplatelet therapy," the researchers write.
"Pending additional evidence, however, the results
of this study may suggest that PPIs should be used for patients with a
clear indication for the medication, such as history of gastrointestinal
tract bleeding, consistent with current guideline recommendations,
rather than routine prophylactic prescription. Alternative
gastrointestinal tract medication regimens also may be considered until
additional data regarding concomitant use of PPI and clopidogrel becomes
available."
Keep up with the latest news for senior citizens, baby
boomers
