Plavix plus PPI equals risk, JAMA says

A month after the FDA announced it would study the interaction of anti-clotting blockbuster Plavix and anti-heartburn meds, a new study is showing that heart attack patients using the two together have an increased risk of more heart trouble. Published in this week's Journal of the American Medical Association, the study of 8,205 heart patients found that those taking Plavix (clopidogrel) are 86 percent more likely to end up in the hospital with another heart attack if they're also using a proton pump inhibitor such as Nexium, Prevacid or Prilosec.

As you know, the Bristol-Myers Squibb anticlotting drug is a standard therapy for heart attack patients as cardiologists aim to prevent the blood clotting that might cause another incident. The heartburn drugs appear to make Plavix less effective, the study shows. The researchers suggest that doctors use different heartburn drugs in patients taking Plavix. Doctors certainly shouldn't routinely prescribe PPI drugs to Plavix patients, but reserve them for patients at higher risk of gastrointestinal bleeding, the lead author told the Wall Street Journal.

Bristol spokeswoman Laura Hortas said the company and Sanofi-Aventis--which markets Plavix in Europe--are "working with the FDA, and conducting studies to obtain additional information that will allow us to understand and characterize the factors that may influence this complex issue."

Ironically, it's not Plavix or Bristol/Sanofi that's most likely to suffer from this news. Plavix will remain the standard therapy. it's the heartburn drugs in the line of fire, as the researchers' comments show. Already, AstraZeneca, which makes the PPI drug Nexium, has seen its stock suffer on the news. Morgan Stanley analysts said that a falloff in Nexium use could hit the company's EPS by as much as 2.8 percent.

- see the WSJ story
- get more from HealthDay
- read the CTV article
- find the AstraZeneca analysis at the Guardian