PLAVIX and PPI in ACS

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The Journal of the American Medical Association, March 4, 2009 (Vol. 301, No 9 Pg. 937-944), contains an article entitled Risk of Adverse Outcomes Associated with Concomitant Use of Clopidogrel (PLAVIX) and Proton Pump Inhibitors (PPI) following Acute Coronary Syndrome (ACS).
Available proton pump inhibitors (PPI) include:

• omeprazole (Prilosec),
• lansoprazole (Prevacid),
• rabeprazole (Aciphex),
• pantoprazole (Protonix),
• esomeprazole (Nexium), and
• Zegarid, a rapid release form of omeprazole.

The common treatment for ACS is an inpatient placement of a stent or medical treatment. Upon discharge, the common medical treatment is the use of PLAVIX and daily aspirin is common to protect from thrombosis and ischemia. The PPIs are added to reduce risk of gastrointestinal bleeding.

Of 8205 patients treated with ACS in this manner, a significant number of patients had complications after discharge. Death or rehospitalization for ACS occurred in 29.8% taking PLAVIX plus PPI. The use of the PPI without PLAVIX was not associated with death or rehospitalization.

I have also observed an increase in older diabetic patients who require this re-hospitalization after inpatient treatment for ACS and follow-up treatment with PLAVIX. This leads me to believe that it is time to consider follow-up medical treatment with alternatives to PLAVIX.