Usually, as a course of treatment, patients are
given aspirin to inhibit platelet aggregation after a first heart attack as a
blood thinning agent to help reduce the risk of another heart attack. Along
with, several doctors prescribe PPIs (proton pump inhibitors, drugs used to
help prevent gastric acid reflux) as well for the prevention of peptic ulcers
in patients treated with aspirin.
The study team, led by Dr. Mette Charlot of
Copenhagen University Hospital, Denmark studied a large number of patients
admitted to the hospital with their first episode of myocardial infarction. A
total 19,925 patients were prescribed aspirin within 30 days of discharge and
excluded the ones who took clopidogrel (an antiplatelet/clotting agent). Of
these, 4306 were prescribed for pump inhibitor (PPI) within one year.
During the follow-up, 3366 out of the 19,925 patients experienced
recurrent MI, stroke, or even death following a cardiovascular event
Study reports indicated that the overall rate of adverse Cardiovascular
Events (CV) was significantly much higher among patients who were taking
aspirin and a PPI, than in those who took aspirin alone
. This also holds true for
each of the three adverse events analyzed separately.
In their discussion, Dr. Charlot noted that recent studies found that
patients taking PPIs had a reduced platelet response to aspirin
, which is a strong
possibility for the higher rate of CV events observed in PPI-treated patients
in the current study. Other explanations include an impact of PPIs on gastric
pH, resulting in lower aspirin bioavailability.
The author further added that, "The findings also
have important implications for the ongoing debate regarding a potential
interaction between PPIs and clopidogrel. Interestingly, our study found an
increased CV risk associated with PPIs independent of clopidogrel use".
British Medical Journal reported that investigators call for further
studies in this area to explore a possible pharmacologic interaction between
PPIs and aspirin, which if confirmed would have significant clinical
. Reference article