Plavix Controversies

Several patients have had questions about Plavix (clopidogrel) lately.

Before you read on, if you are on Plavix, DO NOT STOP TAKING IT!  You are likely on it for good reason, and depending on your clinical situation, stopping it may be extremely dangerous.  Talk to your doctor if you have any concerns.

I am not going to get into the scientific nitty-gritty here, just simply an overview.

Combination with a proton pump inhibitor (PPI), such as omeprazole, Protonix, Nexium:
There has been concern that taking Plavix and a PPI together reduces the effectiveness of Plavix.  Small studies on healthy volunteers demonstrated decreased platelet inhibition when Plavix was taken with a PPI.  However, a larger randomized trial, the COGENT trial, which enrolled thousands of patients showed that outcomes were no worse when Plavix and a PPI were combined, and in fact the combination of the two medications reduced risk of gastrointestinal bleeding complications.
Bottom line:  If you are on both Plavix and a PPI, it is likely safe to continue to take both medications.

Resistance to Plavix:
Recently, the FDA published a warning that people with certain genetic mutations may have resistance to Plavix, and these patients tend to have worse outcomes.  This statement certainly sent a flurry of phone calls and questions to cardiologists nationwide.  The problem with this warning is that it is true that these patients do less well, but there is no evidence at this point of exactly what we should do for patients who are resistant to Plavix -- should they receive a double dose of Plavix, or be switched to a different medication such as Effient (prasugrel)?
Bottom line:  Don't stop your Plavix.  Talk to your doctor.