SCAI: No change to heartburn med, clopidogrel routine
The Society for Cardiovascular Angiography and Interventions (SCAI) issued a statement after conflicting data from two studies presented at the 2008 American Heart Association meeting raised concerns about patients taking clopidogrel and proton pump inhibitors.
According to the statement, “The data from the two studies do not provide sufficient evidence to change clinical practice.”
Guidelines authored by SCAI and other cardiovascular organizations recommend dual-antiplatelet therapy, typically clopidogrel plus aspirin, for no less that one year following implantation of stents. Clinical trials have shown this drug regimen effectively prevents late stent thrombosis.
In addition to dual-antiplatelet therapy, physicians sometimes prescribe proton pump inhibitors (PPIs), such as Prilosec, Prevacid and Nexium, to lessen the possibility of gastric bleeding.
Two studies came to opposite conclusions concerning adverse effects when patients take both clopidogrel and PPIs. The first study, a database analysis, found an increase in cardiac events in patients taking clopidogrel along with PPIs. The second study, called CREDO, found no adverse effect when clopidogrel was taken along with a PPI. Patients in this study who were taking a PPI had similar rates of adverse events whether they took clopidogrel or a placebo with a PPI.
The large, randomized study COGENT-1 is expected to clarify the possible interactions between clopidogrel and PPIs, according to SCAI.
“The key message for physicians is to follow the indications and the guidelines,” said Steven R. Bailey, MD, SCAI president-elect. “All patients who have received a stent in the past year should be on dual-antiplatelet therapy. And, if there is a good indication for specific patients to take one of the heartburn medications, then physicians should prescribe them. At this time, there is no compelling evidence to change clinical practice.”
According to the statement, “The data from the two studies do not provide sufficient evidence to change clinical practice.”
Guidelines authored by SCAI and other cardiovascular organizations recommend dual-antiplatelet therapy, typically clopidogrel plus aspirin, for no less that one year following implantation of stents. Clinical trials have shown this drug regimen effectively prevents late stent thrombosis.
In addition to dual-antiplatelet therapy, physicians sometimes prescribe proton pump inhibitors (PPIs), such as Prilosec, Prevacid and Nexium, to lessen the possibility of gastric bleeding.
Two studies came to opposite conclusions concerning adverse effects when patients take both clopidogrel and PPIs. The first study, a database analysis, found an increase in cardiac events in patients taking clopidogrel along with PPIs. The second study, called CREDO, found no adverse effect when clopidogrel was taken along with a PPI. Patients in this study who were taking a PPI had similar rates of adverse events whether they took clopidogrel or a placebo with a PPI.
The large, randomized study COGENT-1 is expected to clarify the possible interactions between clopidogrel and PPIs, according to SCAI.
“The key message for physicians is to follow the indications and the guidelines,” said Steven R. Bailey, MD, SCAI president-elect. “All patients who have received a stent in the past year should be on dual-antiplatelet therapy. And, if there is a good indication for specific patients to take one of the heartburn medications, then physicians should prescribe them. At this time, there is no compelling evidence to change clinical practice.”