To the Editor:
I recently heard of a strong contraindication to giving a proton pump inhibitor (PPI) to patients with coronary heart disease (CHD) who are taking clopidogrel. PPIs, with the possible exception of Protonix, negate the action of clopidogrel and can have significantly deleterious consequences for the patient. I heard this listening to an audio review produced by Johns Hopkins and Oakstone Medical Publishing. The reviewer talked about his electronic search of the literature on the concomitant use of PPIs and clopidogrel. He was astonished by the number of malpractice cases being pursued in regard to this issue.
In the article “Use of drug-eluting stents for patients with coronary heart disease” (published in the August 2009 issue), several recommendations regarding ideal pharmacotherapy for these patients are made. One of which is to give a PPI to help ameliorate the GI symptoms in patients with a drug-eluting stent who cannot take aspirin because of a GI disorder. Following this recommendation would appear to result in very serious consequences.
Hadden Goodman PA-C
Editors' note: At the Transcatheter Cardiovascular Therapeutics meeting, Deepak L. Bhatt, MD, MPH, reported on the COGENT trial, a prospective, randomized, controlled trial on the safety of concomitant use of PPIs and clopidogrel.1 Preliminary analysis data indicates that the combination is safe and reduced the risks of events by 45% compared with clopidogrel alone.
REFERENCE
1. Peck P. TCT: PPIs safe for patient's taking antiplatelets. Medpage Today Web site. http://www.medpagetoday.com/MeetingCoverage/TCT/16133. Accessed October 15, 2009.