Certain Reflux Drugs Tied to Higher Post-Angioplasty Death Rate

People taking the acid reflux drugs Prilosec or Protonix in combination with blood thinners such as Plavix have a higher risk for death after angioplasty than people who don't take the two popular antacids, a new study has found.

The people in the study, which was be presented at the American Heart Association's annual meeting, were undergoing what doctors call percutaneous coronary intervention (PCI), a common procedure used to widen a narrowed artery. PCI typically involves balloon angioplasty followed by the insertion of a drug-emitting stent, a tiny mesh tube, to keep the vessel open.

Study author Joseph Sweeny, MD, an assistant professor of medicine at Mount Sinai Medical Center in New York, said that the clinical implications for users of these reflux drugs, called proton pump inhibitors (PPIs), remain unclear.

"It's a moving target," Sweeny said, adding that, "although certain confounders are going to be at play that do cause limitations of the study, in my opinion the data speaks for itself. We found an overall increased mortality in this patient population that takes a PPI with clopidogrel [Plavix]. The problem was I was not able to look at specific cause of mortality."

PPIs are frequently given with aspirin and Plavix after an angioplasty procedure to reduce the chances of gastrointestinal bleeding. Many people also take PPIs for various gastrointestinal conditions, including acid reflux, gastric ulcers and stomach bleeding.

For the study, Sweeny and colleagues looked back at records of more than 8,300 people who underwent the procedure between April 2003 and June 2007. They were followed for an average of two years.

During the study period, 17% of them took a PPI. All of the patients also took both aspirin and Plavix, the researchers said.

Overall, people taking a PPI had a 30% higher risk for dying after their PCI procedure than did people who were not taking a PPI. Two drugs in the class appeared to contribute most of the added risk: Omeprazole (Prilosec) was associated with 72% higher risk for death after PCI, and pantoprazole (Protonix) was linked to a 54% increased risk, the study found.

Two other common PPIs, esomeprazole (Nexium) and lansoprazole (Prevacid), did not show a heightened risk. There wasn't enough data to rank a fifth drug, Aciphex (raberprazole), according to the study.

Sweeny could not say why Nexium and Prevacid were exempt from the effect. "It's a very heterogenous interaction and depends on how a specific population metabolizes that drug," he said.

— Source: Brigham and Women's Hospital