Benefits Of Anti-Clotting Medications Reduced By Common Heartburn Drugs
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The anti-clotting operation of the medication clopidogrel (Plavix) can be compromised by familiar drugs for the treatment of heartburn and ulcers resulting in a roughly 50% aggrandizement in the combined risk of hospitalization for love attack, stroke and other grave cardiovascular illnesses, according to a late study presented at the Nation for Cardiovascular Angiography and Interventions (SCAI) 32nd Annual Scientific Sessions. The study specifically focused on the part of proton pump inhibitors (PPI) omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), and lansoprazole (Prevacid), which together accounted for about 96% of PPI apply in the study.
Patients who hire a drug-eluting stent avail from enchanting anti-clotting medications, including thienopyradines (such as clopidogrel or ticlopidine) and aspirin, for at least one year consequent the procedure. Doctors often very prescribe PPIs to patients taking clopidogrel owing to of pre-existing belly disease or to diminish the risk of common side item such as nausea and gastroesophageal reflux (heartburn). Before clopidogrel can exert its anti-clotting effects, it must be converted from its inactive, pro-drug arrangement to an active drug by enzymes in the liver. PPIs - the sixth most commonly prescribed narcotic party in the U.S. - can interfere with those liver enzymes, according to the study.
"Given the large digit of patients who undergo coronary stent procedures everyone year, and the recommended and broad use of clopidogrel following this procedure, our findings own implications for many thousands of patients across the United States," said Eric J. Stanek, PharmD, senior employer of research, personalized medicine research and development, Medco Health Solutions, Franklin Lakes, NJ, and the study's principal investigator. "Clopidogrel should advance to be taken as prescribed, and the need for PPI therapy should be carefully evaluated to insure that it is prescribed only when clearly indicated."
For the study, researchers analysed integrated counsel on drugstore and medical claims from more than 10 million patients, including 16,690 patients taking clopidogrel for a comprehensive year adjacent coronary stenting. Of these, 41% besides took a PPI, on average, for more than nine months of the year. Over that 12-month space when patients took clopidogrel, investigators evaluated the risk of hospitalization for major adverse cardiovascular events (MACE), which they defined as a combination of heart attack, unstable angina, stroke or brief stroke-like symptoms, repeat coronary procedures, or cardiovascular death.
The overall MACE risk was 51% higher among patients captivating any PPI. The findings were equally concerning when the factor of lone PPIs were analyzed. Omeprazole correlated with a 39% increased risk of MACE, esomeprazole to a 57% increased risk, pantoprazole to a 61% increased risk and lansoprazole to a 39% increased risk. All of the associations were highly statistically significant. Overall, the incidence of hospitalization for upper gastrointestinal bleeding was matchless 1.1% among patients fascinating a PPI and 0.07% among those not taking a PPI.
Additional proof is needed to arbitrate whether newer, less widely used PPIs such as rabeprazole (Aciphex) and dexlansoprazole (Kapidex) are also associated with increased cardiovascular risk in patients taking clopidogrel. Researchers are also interested in examining how genetic variations in the liver enzymes that activate clopidogrel might alter the impression of PPIs on clopidogrel effectiveness, the potential influence of the timing of PPI administration, the end product of modify dosing of clopidogrel, and the comparative effectiveness of other anti-clotting medications.
This study was supported independently by Medco Health Solutions, Inc, and conducted in collaboration with investigators from the Indiana University Institute of Medicine.
Kathy Boyd David
Country for Cardiovascular Angiography and Interventions
View drug dossier on Aciphex; Nexium; PLAVIX.
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