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Omeprazole Shows Benefit With Aspirin, Clopidogrel

Treatment in patients on dual antiplatelet therapy linked to fewer gastrointestinal events

WEDNESDAY, Oct. 6 (HealthDay News) -- Omeprazole may be associated with a lower risk of upper gastrointestinal bleeding in patients taking aspirin and clopidogrel, without a significant increase in risk of cardiovascular events, according to research published online Oct. 6 in the New England Journal of Medicine.

Deepak L. Bhatt, M.D., of the Veterans Affairs Boston Healthcare System, and colleagues analyzed data from 3,761 adults with an indication for dual antiplatelet therapy who were randomized to receive clopidogrel with either omeprazole or placebo, in addition to aspirin.

The researchers found that the risk of a gastrointestinal event at 180 days -- including overt or occult bleeding, symptomatic gastroduodenal ulcers or erosions, obstruction, and perforation -- was lower in the omeprazole group (hazard ratio, 0.34). The rate of overt upper gastrointestinal bleeding was also lower with omeprazole (hazard ratio, 0.13). Rates of cardiovascular events -- including death from cardiovascular causes, nonfatal myocardial infarction, stroke, and revascularization -- were statistically similar in the groups. Rates of serious adverse events were also similar in the groups, though omeprazole was associated with higher diarrhea risk.

"Further research will be necessary to determine the optimal approach to reducing the risk of gastrointestinal adverse events among patients receiving potent antithrombotic therapy, but prophylactic proton-pump inhibition appears to be promising," the authors conclude.

The study was supported by Cogentus Pharmaceuticals, which helped design the trial. Several authors disclosed financial relationships with various pharmaceutical companies, including Cogentus.

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