Plavix, PPI Combo: Risky for Heart Patients?
Study Shows Risks of Combining Plavix and Proton Pump Inhibitors
March 3, 2009 -- Heart attack patients who take
an acid-reducing proton pump inhibitor (PPI) drug like Prilosec or Nexium in combination with the
antiplatelet drug Plavix are more likely to have
a second heart attack than patients who don't take PPIs, according to new
The findings confirm several smaller trials and one larger one, reported
just weeks ago, suggesting that PPIs can inhibit the blood clot-inhibiting
activity of Plavix, also known as clopidogrel.
Heart patients in the study who took Plavix with a PPI had a 25% increased
risk of dying or of requiring hospitalization for heart-related issues,
compared to patients who took Plavix alone, says study researcher P. Michael
Ho, MD, PhD of the Denver VA Medical Center. Even after adjusting for factors
such as patient age and other health factors, the concomitant use of Plavix and
a PPI was still associated with a substantially higher risk of subsequent heart
attacks or need for revascularization procedures.
The study appears in the March 4 issue of TheJournal of the American
"It is increasingly clear that PPIs should not be prescribed to patients
taking clopidogrel unless there is a good indication for doing so," Ho
PPIs Routinely Given With Plavix
Along with aspirin, Plavix is routinely
prescribed after a heart attack or as part of treatment for heart conditions
like unstable angina to prevent potentially
life-threatening blood clots from forming.
PPIs, such as Prilosec, Nexium, Prevacid, Aciphex, and Protonix, are often prescribed
as well to reduce the risk of gastric bleeding from the blood-thinning
But several recent studies suggest that patients who take Plavix and PPIs
together have an increased risk for recurrent heart attacks and death from
other heart-related causes.
In an effort to shed light on the issue, Ho and colleagues followed more
than 8,000 patients treated for heart attacks or unstable angina at 127
Veterans Administration hospitals across the country.
Plavix was prescribed to all the patients, and 64% were prescribed a
Over three years of follow-up, about 30% of the patients who took Plavix
plus a PPI either died or were hospitalized for heart-related causes, compared
to 21% of the patients who took the antiplatelet drug without a PPI.
Taking Plavix with a PPI at any time during the follow-up was associated
with a 25% increase in risk for death or hospitalization.
American Heart Association president Timothy Gardner, MD, tells WebMD that
it is now clear that PPIs should be prescribed cautiously to heart patients
"If a patient has a history of GI bleeding, we know that [Plavix] can
increase the risk of recurrence," he says. "It may be that we need to
limit the use of PPIs to these patients and other patients who have a clear
need for protection."