Treatment with a combination of aspirin and clopidogrel (marketed as Plavix®) has been shown to reduce recurrent cardiovascular events after hospitalization for acute coronary syndrome.

Due to the risk of gastrointestinal bleeding associated with this combination therapy, proton pump inhibitors (PPIs) are often prescribed as a protective medication. However, using a PPI may reduce the benefits of clopidogrel after acute coronary syndrome, according to a study published in the March 4, 2009 issue of the Journal of the American Medical Association .

Investigators from the Denver VA Medical Center and their colleagues evaluated the outcomes of 8205 patients with acute coronary syndrome (ACS) taking clopidogrel after discharge from 127 Veterans Affairs hospitals between October 1, 2003 and January 31, 2006. They found that, 5244 of these patients were prescribed a PPI. Statistical analyses revealed that ACS patients who were treated with both clopidogrel and a PPI had an increased risk of death or rehospitalization for ACS compared with those who were treated with clopidogrel alone.

The results of this study show that PPI medications are frequently prescribed with clopidogrel following hospitalization for ACS and the simultaneous use of these medications is associated with a higher risk of adverse outcomes. It may be that PPIs reduce the antiplatelet effects of clopidogrel, but further studies are needed to confirm these results in order to determine the appropriate indications for PPI use after an ACS hospitalization.

Source

JAMA. 2009;301(9):937-944.