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SCAI Statement on 'A National Study of the Effect of Individual Proton Pump Inhibitors on Cardiovascular Outcomes in Patients Treated with Clopidogrel Following Coronary Stenting: The Clopidogrel Medco Outcomes Study'
Date:5/6/2009

LAS VEGAS, May 6 /PRNewswire/ -- Results of the Clopidogrel Medco Outcomes Study presented today during SCAI's Annual Scientific Sessions found the anti-clotting benefits of clopidogrel (Plavix) may be reduced when taken concurrently with commonly used heartburn medications called proton pump inhibitors (PPIs). In the study, patients taking clopidogrel and a PPI experienced a:

  • 50% increase in the combined risk of hospitalization for heart attack, stroke, unstable angina, or repeat revascularization, including:
    • 70% increase in the risk of heart attack or unstable angina
    • 48% increase in the risk of stroke or stroke-like symptoms
    • 35% increase in the need for a repeat coronary procedure

Dual antiplatelet therapy, which commonly consists of clopidogrel and aspirin, is routinely prescribed to patients following insertion of stents to prevent life-threatening blood clots. PPIs are also frequently prescribed to these patients for brief periods (approximately 30 days) following stent insertion to treat unpleasant but non-life-threatening side effects of clopidogrel such as nausea. In some patients PPIs may also be taken routinely for gastrointestinal conditions like peptic ulcer disease.

The Clopidogrel Medco Outcomes Study is the largest to date to examine the outcomes of patients who are taking clopidogrel and a PPI. However, two smaller, earlier studies came to opposite conclusions concerning adverse effects when patients were taking both medications. The first study, a database analysis, found an increase in cardiac events in patients taking clopidogrel along with a PPI, while the CREDO study found no adverse effect when clopidogrel was taken along with a PPI.

The current study examined outcomes of patients taking common PPI medications including
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SOURCE SCAI
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