Aciphex (Rabeprazole)

Medco study: PPIs reduce clopidogrel efficacy post-stenting

The efficacy of clopidogrel after stent implantation is reduced by the concomitant use of proton pump inhibitors (PPIs), according to a study presented today at the Society for Cardiovascular Angiography and Interventions (SCAI) Scientific Sessions in Las Vegas. Researchers at Medco used data from 16,690 patients taking clopidogrel after stenting and found that the risk of major adverse cardiovascular events was raised from 17.9% to 25.1% in patients also taking PPIs.

The elevation in risk remained statistically significant for the individual PPIs omeprazole, esomeprazole, pantoprazole, and lansoprazole. The results are consistent with a recent VA study of 8,000 ACS patients published in JAMA.

“Given the large number of patients who undergo coronary stent procedures each year, and the recommended and wide use of clopidogrel following this procedure, our findings have implications for many thousands of patients across the United States,” said Eric J. Stanek, PharmD, senior director of research, personalized medicine research and development, Medco Health Solutions, Franklin Lakes, NJ, and the study’s principal investigator, in a SCAI press release. “Clopidogrel should continue to be taken as prescribed, and the need for PPI therapy should be carefully evaluated to ensure that it is prescribed only when clearly indicated.”

SCAI also issued a statement about the study and made several recommendations:

“SCAI believes more research is needed on this topic. However, given the thousands of patients who receive stents each year, coupled with the significant risks demonstrated in this study, SCAI recommends the use of alternative medications for GI symptoms in patients with stents when appropriate.  Other effective treatments for heartburn and ulcers include histaminergic (H2) blockers (Zantac, Tagamet) or antacids.  In some patients the use of PPIs may still be warranted  based on the patient’s medical problems and should be taken at the direction of the patient’s cardiologist, gastroenterologist or primary physician.

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