Monday, May 11, 2009

Stent Patients Advisory: Switch Heartburn Drugs


Anyone taking the clot-preventing drug Clopidogrel (Plavix) after receiving a stent in a coronary artery opening procedure should avoid a type of popular heartburn medications called proton pump inhibitors (PPIs).

PPIs include medications such as Nexium, Prevacid, Protonix, Aciphex and Prilosec.

The Clopidogrel (Plavix) Medco Outcomes Study was recently presented at the Society for Cardiovascular Angiography and Interventions (SCAI)’s annual scientific sessions.

The study reported patients taking both Plavix and PPIs experienced a 50% increase in the combined risk of hospitalization for heart attack, stroke, unstable angina (chest pain), or repeat revascularization. A more in depth review demonstrates patients who received a PPI had a 70% increase in the risk of heart attack or unstable angina; 48% increase risk of stroke or stroke-like symptoms’ and a 35% increase in the need for a repeat coronary procedure.

This study followed 16,690 patients taking Plavix for a full year following coronary stenting. The patients in the study were taking PPIs – Protonix, Nexium, Prilosec, and Prevacid for an average of nine months post stenting. This trial did not look at outcomes in patients on newer PPIs such as Aciphex or Kapidex. The experts report that PPIs decrease the efficacy of Plavix secondary to decreased absorption as compared to the population of patients who used Plavix alone.

Patients who receive a stent are prescribed Plavix to prevent clots from developing. Plavix does increase the risk of bleeding and GI upset; therefore, many providers have routinely given PPIs to patients taking Plavix to prevent gastrointestinal side effects.

The SCAI now suggest providers who are treating post stenting patients on Plavix therapy to consider prescribing histaminergic (H2) blockers such as Zantac or Tagament or antacids instead of a PPIs due to the high risk for adverse events with Plavix and PPI combination as demonstrated in this recent study.

If you are currently taking Plavix and a PPI, I would encourage you to discuss this combination with your health care provider. Perhaps a H2Blocker would be a better treatment for you.