Nov. 8, 2010 -- The benefits of using a common class of heartburn drugs in combination with antiplatelet therapy in people with heart disease outweigh the risks for most people with a history of gastrointestinal (GI) problems, according to new guidelines.
But researchers say more studies are needed to fully understand the potential impact of using these two popular classes of drugs together.
Antiplatelet drugs, such as Plavix, are used to help prevent potentially dangerous blood clots from forming in people with heart disease. But these antiplatelet drugs also increase the risk of bleeding, including upper GI bleeding.
Proton pump inhibitors (PPIs), such as Prevacid and Prilosec, which suppress gastric acid production, are routinely prescribed to combat the potential GI side effects of heart disease treatment. But recent reports had suggested that there might be a potentially dangerous interaction between the two drug classes whereby PPIs reduce the actual effectiveness of antiplatelet agents.
In a joint report issued by the American College of Cardiology, American College of Gastroenterology, and the American Heart Association, researchers say the two drugs can be used together after careful consideration of the benefits and risks for each individual.
“Use of PPIs and antiplatelet drugs must be individualized, not done as a matter of routine,” researcher Mark A. Hlatky, MD, a cardiologist at Stanford University School of Medicine, says in a news release. “In patients at high risk of GI bleeding who require antiplatelet therapy for heart disease, the balance of risk and benefit favor use of PPIs together with antiplatelet drugs. In patients at low risk of GI bleeding, however, the balance of risk and benefit tips away from using PPIs together with antiplatelet drugs."
The report, which will appear in the Journal of the American College of Cardiology, along with journals published by each organization, analyzed recent research on the use of proton pump inhibitors along with antiplatelet therapy in people with heart disease.
Following a 2008 recommendation to use the two drugs together in people at high risk for both heart disease and upper GI bleeding, researchers say new data suggest that proton pump inhibitors may lessen the antiplatelet effects of drugs like Plavix, thus increasing the risk of complications from heart disease.
But these studies measured differences in drug levels and platelet function rather than actual side effects in users of the combination therapy. Further research showed using PPIs along with Plavix did not lead to any significant increase in the risk of heart disease events like heart attack or stroke.
In addition, the first randomized study in 3,762 people with heart disease showed use of PPIs along with Plavix reduced the risk of upper GI bleeding by 56% without any increase in the risk of heart disease complications.