Proton Pump Inhibitors Do Not Interfere with Benefit of Antiplatelet Drugs

Boston, Massachusetts (PressExposure) September 14, 2009 -- An analysis of a large clinical trial has shown that proton pump inhibitors (a commonly prescribed antacid medication) do not interfere with the clinical benefit of the anticlotting drugs clopidogrel or prasugrel in patients after an acute coronary syndrome (heart attack or unstable angina). These findings are in contrast to other recent studies that have shown potential harm when these two classes of drugs are combined. The results are published in an Article Online First and in an upcoming edition of the Lancet, written by Dr Michelle O'Donoghue, Brigham and Women's Hospital, and colleagues.

Proton pump inhibitors are often administered with clopidogrel and prasugrel, to help reduce the risk of gastrointestinal bleeding, a strategy that is endorsed by existing guidelines. But several studies have raised concerns that proton pump inhibitors could negate the clinical benefit of clopidogrel. The authors studied the effects of proton pump inhibitors in the TRITON-TIMI 38 trial. The trial enrolled 13608 patients after a heart attack or unstable angina and randomly assigned them to clopidogrel or prasugrel. Use of a proton pump inhibitor in combination with these drugs did not increase the risk of cardiovascular events, including death, heart attack, or stroke.

The authors conclude: "The current findings do not support the need to avoid concomitant use of proton pump inhibitors, when clinically indicated, in patients receiving clopidogrel or prasugrel."

In an accompanying Comment, Dr Dirk Sibbing and Dr Adnan Kastrati, Technische Universität München, Munich, Germany, agree that patients with a risk profile similar to those patients in the TRITON-TIMI 38 study can be safely treated with a proton pump inhibitor on top of clopidogrel or prasugrel. They say: "Caution is however required when prescribing proton pump inhibitors in selected high risk patients with intrinsic reduced response to thienopyridines," adding that, if absolutely needed, PPIs less likely to interfere with the anticlotting effect of thienopyridines may be given to such patients.

About Brigham and Women's Hospital

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit Brigham and Women's Hospital
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Press Release Submitted On: September 14, 2009 at 5:51 am
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