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Two Medications Commonly Prescribed After Heart Attack May Be Risky Together

Heart attack survivors are frequently given blood thinners to help prevent another heart attack. Often, they also receive a drug to prevent bleeding in the stomach. But now a new study shows two medications, clopidogrel (also known by other names, including Plavix) for the heart and PPIs (such as Nexium and Prilosec) for the stomach, given together, may be risky.

Studies show that heart attack survivors who follow their doctor's orders and take medicine as prescribed live longer than those who do not.

But a new study has doctors reexamining the medicines they prescribe.

Doctors at the Denver Veterans Medical Center studied the interaction beween two popular drugs.

Dr. John Rumsfeld is one of the researchers.

"We very often prescribe both clopidogrel, which is a blood thinning medicine, sort of like a super-aspirin, along with drugs that protect the stomach," he said.

Clopidogrel is the generic name for Plavix. It helps prevent blood clots, heart attack and stroke. But it can irritate the stomach and cause bleeding.

So Dr. Thomas Maddox says doctors often prescribe another medication for patients on clopidogrel.

"A lot of times just because we know there is a higher risk of bleeding with clopidogrel, we'll use these proton pump inhibitors or PPIs," he said.

Nexium and Prilosec are two popular PPIs. The researchers followed thousands patients who had a heart attack or other heart disease and were taking clopidogrel when they were released from the hospital.

Dr. Michael Ho led the study.

"We found that patients who were taking clopidogrel and a proton pump inhibitor medication, compared to those who were only taking clopidogrel alone, had about a 25 percent increased risk of having another heart attack or dying following the hospitalization," he said.

Nearly two thirds of the patients in the study were taking both drugs together.

"If a given patient is going to get clopidogrel after a heart attack, which the guidelines strongly recommend, [then] you should only give them a PPI medication if they have a very strong compelling reason for it," Dr. Rumsfeld said.

Doctors say if a patient has already been treated for a stomach bleed, then a PPI may be needed, but it should not be prescribed just as a precaution.

The study was published in the Journal of the American Medical Association.