Post-heart attack drug interactions

March 3, 2009 3:24:15 PM PST
Heart disease kills more Americans annually than any other illness. Now, new research shows a combination of medicines commonly given to those who survive a heart attack may actually do more harm than good. When these kinds of studies are released, people become concerned if they are on these mediation. Note to readers: No one should stop any medication without first speaking to your doctor.

It is common for heart attack survivors to be on one or more medications, with the goal of preventing other heart attacks.

One of the drugs often prescribed is clopidogrel, marketed as plavix.

"We very often prescribe both clopidogrel, which is a blood thinning medication, sort of like a super-aspirin, along with drugs that protect the stomach," said Dr. John Rumsfeld, of the Denver VA Medical Center.

"A lot of times, just because we know there is a higher risk of bleeding with clopidogrel, we'll use these proton pump inhibitors, or PPIs," added Dr. Thomas Maddox.

PPIs are also known as acid blockers. They include prilosec, prevacid, nexium, aciiphex and protonix.

But a question came up about how plavix and PPIs were interacting. So doctors in Denver studied more than 8,000 patients who'd had a heart attack and had been discharged from the hospital with prescriptions for plavix.

Patients who were combining plavix with a PPI were at higher risk for more heart problems.

"We found that in patients who were taking clopidogrel and a proton pump inhibitor medication, compared to those who were only taking clopidogrel alone, had about a 25 percent increased risk of having another heart attack or dying following the hospitalization," Dr. Michael Ho said.

Death or rehospitalization occurred in 21 percent of patients taking plavix alone. But it was 30 percent in those taking both plavix and an acid blocker.

"We did find that almost two-thirds of patients we looked at were taking both medicines together, so this has implications for a large number of patients," Dr. Ho said.

All of these drugs are very effective taken separately. It's only this combination that raises the risk slightly. And only a doctor and patient can together decide if the risk outweighs any benefits.

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WEB PRODUCED BY: Bill King


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