By Michael Gibson Morris/NEMS Daily Journal
New studies are calming fears about using Plavix and proton pump inhibitors like Prilosec together.
Doctors had often prescribed Plavix – a blood thinner – and a proton pump inhibitor – a stomach acid reducer – together to reduce the risk of gastrointestinal bleeds in people who received cardiac stents. In November, the FDA issued a warning based on a laboratory test. Since then, two more studies, looking at the effects in people, not test tubes, have been reported.
“Two other studies have not shown any increased heart risk, and one of the studies showed an increased risk of GI bleeding if you didn’t have Prilosec,” said Tupelo cardiologist Dr. Barry Bertolet.
However, after the FDA ruling, many patients were pulled off their acid-reducing medicine. That was trouble because the drugs like Prilosec are very effective and widely used in controlling painful heartburn and avoiding the long-term damage that can increase the risk of esophageal cancer, said Tupelo gastroenterologist Dr. John Phillips.
The problem centers around platelets, the part of the blood that helps create a scab when we cut ourselves. They work by sticking together. Unfortunately, platelets also can cause clots in our blood vessels, causing heart attacks and strokes. In people who have stents to keep previously clogged arteries open, the platelets can stick to the stent and create a new block.
“Plavix works by making the platelets less sticky,” Phillips said.
However, for Plavix to work, it has to be converted into an active form in the liver, Phillips said. The PPI drugs inhibit that enzyme pathway, creating a theoretical show down.
The FDA issued a warning in November after lab tests showed platelets in a test tube stayed sticky when exposed to Plavix and Prilosec.
In the Triton and Cogent studies, which involved people, there was no increased cardiac risk. The Cogent study, which ended early, showed there was significant GI benefits to using Prilosec.
“It will probably take more studies to put the issue to rest,” Phillips said.
In January, Cardiology Associates began screening patients to see how well Plavix is working, Bertolet said.
“We’ve tested plenty where Plavix and the PPI were working perfectly,” Bertolet said.
When Plavix isn’t working well, then they make adjustments to one or both of the medications, depending on the individual patient, Bertolet said.