Heart attack patients who take a combination of Plavix, plus a proton pump inhibitor such as Prilosec or Nexium, may be at increased risk of death or another heart attack, according to a new study.

Nexium and other proton pump inhibitors, like Wyeth’s Protonix and Prevacid, Eisai Co.'s Aciphex, are used to treat heartburn, in which stomach acids come back up the esophagus, causing pain and inflammation. The drugs are usually prescribed for patients taking Plavix because the drug has been associated with a higher risk of ulcers.

“A lot of patients are on Plavix and also a lot of patients are being prescribed PPI medication just prophylactically to prevent a stomach bleed,” lead researcher Dr. P. Michael Ho, a cardiologist at the Denver VA Medical Center, was quoted as saying.
Plavix is used to thin a patient's blood after a heart attack.

The team of researchers looked at data on 8,205 patients discharged from 127 Veterans Affairs hospitals after suffering a heart attack or unstable angina. Nearly 65 percent of them were prescribed a proton pump inhibitor.

The study revealed that 29.8 percent of patients given a PPI and Plavix died or were re-hospitalized, compared with 20.8 percent of the patients given Plavix alone. Patients who got both drugs were about 50 percent more likely to require a procedure to reopen a coronary artery, according to the report. Among those that had no previous history of stomach or intestinal bleeding, people getting the combination of a PPI and Plavix were still about one-third more likely to experience a serious heart problem during the follow-up period than those getting clopidogrel without a PPI.

Previous studies have shown that patients suffering from acute coronary syndrome who stop taking clopidogrel (Plavix) may be more likely to die or to suffer an acute myocardial infarction especially in the first 90 days after cessation.

About 775,000 people have mild heart attacks or chest pain known as acute coronary syndrome in the United States each year.

The report is published in the March 4 issue of the Journal of the American Medical Association.

A report published in January concluded that people taking Plavix and a proton pump inhibitor after a heart attack had a dramatically higher risk of a second heart attack than those taking Plavix alone.

The researchers note, however, that the study does not change the reasons for prescribing Plavix, but doctors should look more carefully at why the PPI medication is being prescribed. They caution that the drug should not be prescribed prophylactically just to prevent a GI bleed, because there might be an interaction between the PPI and Plavix.
“A lot of us just prescribe things out of habit,” says study coauthor P. Michael Ho. “My hope is that this study makes physicians think twice.”