Relationship of PPI and Blood Thinners Studied

Washington, DCThe potential for over-prescribing of the Proton Pump inhibitor (PPI) aside, a recent study was launched attempting to determine the relationship between the PPI and blood thinners—the latter taken on a regular basis by a host of Americans with coronary heart disease to prevent blood clots. The concern, according to the October 12th edition of the Washington Post, was if the use of proton pump inhibitors serves to inhibit the role and effectiveness of blood thinners.

To achieve an answer to that question, 3,761 adults suffering from coronary artery disease and averaging in their sixties were selected at random. All were taking a blood thinner to manage their heart disease. For the purposes of the study, participants were assigned clopidogrel (Plavix) in combination with either the PPI omeprazole (Prilosec) or a placebo. The report also revealed that all study participants took daily aspirin as part of their heart-management regimen.

Did the emergence of proton pump inhibitors side effects appear as unique amongst those taking the blood thinner versus those who were not?

The study found that at the conclusion of six months, three percent of study participants amongst the placebo group suffered bleeding and ulcers, whereas such symptoms were experienced in only one percent of the group taking the PPI in concert with the blood thinner.

Further, those undertaking the study found that within the six-month window of the study, a total of 109 study participants experienced some kind of cardiovascular event or problem. However, it was concluded that there was no difference in the occurrence rate between the two groups.

The study was useful for two reasons. One is the obvious aging of the baby boomer, with the first wave now hitting retirement age and steering into the time of life when heart ailments can become an ongoing issue. In the ensuing years, there will likely be far more Americans on blood thinners for their heart.

The second concern lay with the apparent over-prescribing of Proton Pump Inhibitor PPI, which could lead to needless PPI side effects.

It was also noted that the PPI omeprazole is only available by prescription. The study—published on the October 6th online issue of the New England Journal of Medicine—did not go beyond the Plavix and Prilosec combination, and thus did not look at the relationship between a blood thinner such as clopidogrel and over-the-counter (OTC) ant-acids favored by some.

It was also noted that the follow-up period was compromised (shorter than initially intended) due to the failure of Cogentus Pharmaceuticals, which funded the study. Cogentus went out of business last year.

The use of proton pump inhibitors has been known to result in PPI hip fractures and other adverse reactions. One of the problems associated with PPI stems from the fact that when proton pump inhibitors were approved by the US Food and Drug Administration (FDA) in 1989, they were intended for only short-term use to treat astroesophageal reflux disease (GERD). However, doctors have the right to prescribe drugs off-label and beyond the recommendations of the FDA. Some patients have been taking PPI for years at a time.

A recent report suggested that it was better to treat the underling cause of GERD, rather than keep prescribing a drug originally intended for short-term use. In so doing, various side effects such as PPI fractures might be avoided.