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Plavix, Heart Burn Drug Combo Risky for Stent Patients, Study Says

Nov 12, 2008 | Parker Waichman LLP

Taking Plavix along with certain heartburn medications could be dangerous to stent patients.  According to a recent analysis of a database kept by pharmacy benefits manager Medco Health Solutions Inc,  the combination of Plavix and proton pump inhibitors, such as Nexium, places these patients at a greater risk of heart attack, stroke and other dangerous health problems than those who took Plavix alone.  

Plavix is used to prevent blood clots after a recent heart attack or stroke, and in people with certain disorders of the heart or blood vessels.  The medication keeps the platelets in the blood from coagulating to prevent unwanted blood clots that can occur with certain heart or blood vessel conditions.

Proton pump inhibitors are used to treat chronic heartburn.    In addition to Nexium, other prescription proton pump inhibitors include Protonix and Prevacid.

The Medco study followed more than 16,000 patients in the database from 2005 to 2006.  Of the patients inthe study, 9,862 patients were taking Plavix alone;and 6,828 patients were taking Plavix and a proton pump inhibitor.

All patients in the  study had been implanted with a wire-mesh tube - a stent -  to prop open arteries after they have been cleared of plaque. The study tracked whether they had been hospitalized for  heart and circulatory problems within a year of the stent being implanted.

Of those who had not had a previous heart attack, only 21.2 percent of patients experienced a serious event within a year of their stent surgery.  That number rose to 32.5 percent among those who took Plavix and a proton pump inhibitor.

Of those who did have a previous heart attack, 39.2 percent were hospitalized for a serious heart or circulatory event.  For those taking only Plavix, only 26.2 percent did.

The database did not include patients who took over-the-counter proton pump inhibitors.  Medco's chief medical officer and lead researcher on the study, Robert Epstein, told the Associated Press that the percentage of those who experienced a serious event  would likely be even higher if such drugs were included in the study.

"Considering the widespread use of these two medications, this important research adds to a growing body of evidence raising questions about their concurrent use and suggests further research is needed," Epstein said in press release announcing the study's findings.

According to The Wall Street Journal, a study published  in the journal Circulation in 2003 showed that nearly 30 percent of Plavix patients don't process the drug effectively.  The Medco study could be an important clue as to why.  People on Plavix are often prescribed proton pump inhibitors because Plavix has been linked to a higher risk of ulcers.

For Plavix to work, it must first be converted to its active form by a liver enzyme.  The Medco researchers said proton pump inhibitors  According to the Medco researchers, these drugs interfere with the liver enzyme, thereby reducing the amount of Plavix that is converted to an active form.


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