For Coronary Patients, H2RA Plus Clopidogrel Spikes Risk

Combo treatment does not appear to be safer option than PPI plus clopidogrel
By Jeff Muise
HealthDay Reporter

THURSDAY, Oct. 28 (HealthDay News) -- The concomitant use of a histamine2-receptor antagonist (H2RA) and clopidogrel for patients with prior acute coronary syndrome (ACS) more than doubles the risk of rehospitalization or death compared to treatment with clopidogrel only, according to research published in the October issue of Gastroenterology.

Chun-Ying Wu, M.D., of the Taichung Veterans General Hospital in Taiwan, and colleagues retrospectively studied 6,552 patients discharged from the hospital after ACS treatment during 2002 to 2005. The researchers compared five treatment groups for a combined primary outcome of all-cause mortality or rehospitalization within three months: clopidogrel plus H2RA, clopidogrel plus proton pump inhibitor (PPI), clopidogrel only, H2RA only, and PPI only.

After one year, the primary outcome occurred in 26.8 percent of the clopidogrel plus H2RA group, 33.2 percent of the clopidogrel plus PPI group, 11.6 percent of the clopidogrel-only group, 11.0 percent in the PPI-only group, and 11.8 percent in the H2RA-only group. The researchers found that H2RA and PPI independently predicted adverse outcomes (adjusted hazard ratios, 2.48 and 3.20, respectively).

"To date, this is the first study in the literature that was set out to investigate whether H2RA would be an alternative to PPI in patients receiving clopidogrel who are at risk for atherothrombotic diseases. We found that, in patients who were discharged for ACS, concomitant use of clopidogrel and H2RAs was associated with 2.5 times increased risk of rehospitalization for ACS or all-cause mortality compared with patients receiving clopidogrel alone," the authors write.

One study author disclosed financial ties to pharmaceutical companies.

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