PPIs may cut bleeding risk in MI patients on antithrombotic drugs

Last Updated: 2015-10-27

By Larry Hand

NEW YORK (Reuters Health) - Proton pump inhibitors (PPIs) may help decrease the risk of gastrointestinal bleeding in myocardial infarction patients taking antithrombotics and non-steroidal anti-inflammatory drugs (NSAIDS), according to results of a new study.

Dr. Anne-Marie Schjerning Olsen, of Copenhagen University Hospital Herlev and Gentofte in Hellerup, Denmark, and colleagues analyzed administrative registry data from all Danish hospitals from 1997 to 2011. Adults age 30 and older who were admitted with a first myocardial infarction and who survived at least 30 days after discharge constituted the study population. The average follow-up was 5.1 years.

Among almost 83,000 patients (mean age 67.4, 64% men), the crude incidence rate of bleeding events came to 1.8/100 person-years with PPIs and 2.1/100 person-years without PPIs.

All patients were taking single or dual antithrombotic therapy, 42.5% filled at least one prescription for NSAIDs, and 45.5% were taking PPIs.

In adjusted time-dependent Cox regression models, the risk of bleeding was lower with PPI use (hazard ration 0.72), regardless of antithrombotic regimen, type of NSAID, or type of PPI.

"The results suggest that PPI treatment probably has a beneficial effect regardless of underlying gastrointestinal risk and that when NSAIDs cannot be avoided in post-myocardial infarction patients, physicians might prescribe a PPI as well," the researchers wrote in an article online October 19 in BMJ.

"The study does not clarify whether PPIs might be safely omitted in specific subgroups of patients with a low risk of gastrointestinal bleeding," they advised.

Dr. Chiara Melloni, of Duke University Medical Center, Durham, North Carolina, recently studied the conflicting results of randomized trials and observational studies of PPIs and unstable angina/non ST-elevation myocardial infarction (http://bit.ly/1k6ZRc0).

She told Reuters Health by email, "Data obtained from our systematic review have confirmed that the proton pump inhibitor omeprazole can be safely co-administered in patients with UA/NSTEMI who receive dual antiplatelet therapy. Beside concerns on possible increased risks of cardiovascular outcomes due to clopidogrel and PPI interaction, this data obtained from randomized clinical trials shows that there were no differences in ischemic events, and omeprazole indeed reduced significantly the risk of gastrointestinal bleeding."

"The systematic review has demonstrated that data from randomized controlled trials were available only for omeprazole; for all other PPIs data were available from observational studies and they indicated an increase in ischemic events such as myocardial infarction and mortality," she continued.

"Furthermore, we did not have drug-level data;. . . we looked at a class effect and could not specifically tease out the safety and the efficacy of single PPIs (as we did for omeprazole) when coadministered with dual antiplatelet therapy in UA/NSTEMI patients," she added. "These aggregate data suggest an increased risk, and so support a cautionary approach to PPI prescription in this population."

Dr. Schjerning Olsen did not respond to requests for comment.

The Danish Council of Research and the Novo Nordisk Foundation partially supported this research through grants to two researchers.

SOURCE: http://bit.ly/1O4SDTb

BMJ 2015.