THE TRIALIST

Don't mix PPIs and Plavix...
How many patients are not on a PPI these days?...should they be?

A retrospective study published in JAMA this week strongly suggests that one should be careful when prescribing PPIs upon discharge of patients hospitalized for an acute coronary syndrome (ACS). When comparing the use of a PPI in patients with ACS taking clopidrogel after discharge, Michael Ho et al. found that patients taking clopidrogel and prescribed a PPI had a higher risk of death or rehospitalization for recurrent ACS than those who were taking clopidrogel alone (Adjusted odds ratio 1.25 CI[1.11-1.41]) (1). The results of this study are supported by several translational and mechanistical studies showing that the use of PPIs reduces the antithrombotic effects of clopidrogel (2), (3).

Maybe all of us future interns should follow our pharmacology professor's suggestion to place a bottle of Omeprazol pills under each patient's pillow on the wards. That way, when asked by a tired junior resident to put Mr. Jones on a PPI, we can safely say that he's already "on" it...

(1) P. Michael Ho et al. JAMA. 2009; 301(9): 937-944
(2) Gilard M. et al. J. Thromb Haemost. 2006; 4(11): 2508-2509
(3) Gilard M et al. J Am Coll Cardiol. 2008; 51 (3): 256-260