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The FDA has issued a new warning on an interaction between clopidogrel and the PPI omeprazole and other drugs that inhibit the CYP2C19 enzyme, just weeks after the only randomized trial on this issue reported no such interaction.
Orlando, FL-The FDA has today issued a new public-health warning on the possible interaction between clopidogrel (Plavix, Bristol-Myers Squibb/Sanofi-Aventis) and the proton-pump inhibitor (PPI) omeprazole(Prilosec, Procter & Gamble) [1,2]. The alert states: "New data show that when clopidogrel and omeprazole are taken together, the effectiveness of clopidogrel is reduced. Patients at risk for heart attacks or strokes who use clopidogrel to prevent blood clots will not get the full effect of this medicine if they are also taking omeprazole."
But the timing of the this alert appears peculiar, given that just a few weeks ago, what was said to be the definitive answer to this issuethe only randomized clinical trial on the interactionwas reported, showing absolutely no hint of any reduction in effect of clopidogrel in patients taking omeprazole.Read full article »
Inside: Clinical cardiology
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What effect does doubling the dose of clopidogrel have on outcomes in patients undergoing PCI? Dr. Salim Yusuf discusses the results of the CURRENT-OASIS 7 trial and other new data on antithrombotic agents.
Recently published data suggest that prior polyvascular disease increases the risk for inhospital adverse events in patients with ACS. Join Drs. Deepak Bhatt, Jean-Pierre Bassand, and José R. Gonzalez-Juanatey for a discussion of the current data on identification and management of patients with polyvascular disease.
Although research has demonstrated the effectiveness of ICDs in preventing sudden cardiac death, many eligible patients still do not receive them. Join Drs. Prystowsky, Califf, Al-Khatib, Yancy, and Daniel in a lively discussion on how to eliminate these disparities.
Recent data among heart patients have suggested that approximately 2.3% of patients with a defected implant lead attached to their defibrillator will experience lead fracture within 30 months of having the device implanted. What are your thoughts and is this happening in your clinical practice?
Join Dr. Tardif as he discusses the latest clinical data addressing heart rate-lowering therapy in patients with stable coronary heart disease and left ventricular systolic dysfunction. The role of heart rate-lowering therapy and target populations are reviewed, as well as the next steps required for application to Canadian medical practice.
Management of long-term anticoagulation therapy in STEMI patients is challenging. Please join our expert panel, Drs. Elaine Hylek, Ander Cohen, Greg Lip, and Jack Ansell, as they discuss current challenges and strategies to optimize the benefit of and provide insights to the future of anticoagulation therapy.
How can we reduce the time taken to accurately diagnose ACS? ECGs and biomarkers may be nondiagnostic, even the presenting symptoms can vary or be absent. As every 30 minutes delay is associated with a 7.5% relative increase in mortality, time is indeed muscle. Join Drs. Gibson, Pride, Santini, and Krucoff as they present new insights into this complex field.
The world's first MR-conditional pacemaker system designed for safe use in MRI represents a major milestone in the evolution of ICDs. Dr. Bruce Wilkoff from the Cleveland Clinic speaks on the significance of having this new technology available to patients.
Framingham, Reynolds, CRP, calcium..? How best to assess CVD risk in women? Drs Redberg, Hayes, Lloyd-Jones, and Wenger discuss optimal risk stratification, the utility of preclinical screening and the importance of treating traditional risk factors in female patients.
As part of his mission to see more financial transparency in medicine, Sen Grassley has asked eight top US medical schools about their policies on ghostwriting.
Publicly released report cards based on hospital performance did not result in a measurably greater systemwide improvement in two composite AMI or CHF process-of-care indicators in a Canadian study. But they did appear to stimulate some important changes in delivery of care that could have led to some better outcomes.
The latest evidence for the treatment of STEMI and PCI has been incorporated into a fast-track update of US guidelines. But questions remain about the quality of some of the evidence informing the guidelines and about the composition of the writing committees.
A new analysis confirms that regardless of INR control achieved across participating centers, dabigatran remained noninferior at the lower dose and superior at the higher dose to warfarin for prevention of stroke and systemic embolism.
No significant incidence of short-term cardiac toxicity was observed in breast-cancer patients on dose-dense anthracycline regimens, but longer-term follow-up is needed.
Depression after coronary artery bypass surgery is often overlooked by physicians but is associated with worse outcomes. A new US study illustrates a simple telephone-based approach to tackle this, with nurses encouraging patients to seek help from their primary-care doctors and providing ongoing feedback and review.
New registry data presented this week showed that cardiologists are more likely to select rhythm control over rate control for the treatment of atrial fibrillation, and this strategy is more likely to lead to successful treatment of AF than the rate-control-based approach. Both strategies are equivalent in terms of their effect on clinical outcomes.
Patients with elevated baseline plasma renin activity levels had a twofold increased risk of total or cardiovascular mortality compared with those with low levels, and the strength of the association persisted after multiple adjustments, including the HOPE score, CRP, and BNP.
None of the eight platelet assays studied were able to predict bleeding, but four of the eight, based on ADP-induced platelet aggregation, produced results that correlated with adverse CV outcomes. By contrast, four tests that use shear-stress-induced adhesion-based methods were not predictive.
The role of lipids in women for primary prevention of cardiovascular disease is a challenging issue for all providers. Join Drs. Foody, Mora, and Welty as they discuss limitations to current risk stratification models, recent clinical trial data, and the changing paradigm in the management of lipids in women.
We know there are sex and biological differences in the manifestation of CVD. How do these pathophysiological differences affect the diagnosis and treatment of our female patients? Drs. Hayes, Johnson, Manson, and Piña provide their insight.
Despite increased awareness of CVD in women, contemporary studies demonstrate gender differences in outcomes. Differences in age and comorbidities account for some, but not all of these disparities. Join Dr. Foody as she discusses these issues with Drs. Mieres and Redberg.
Join Drs Valentin Fuster, Roger Blumenthal, Bob Harrington, Judith Hochman, Sanjay Kaul, Suzanne Oparil, Gregg Stone, Lynne Warner Stevenson, and Bruce Wilkoff as they discuss the results of ARBITER 6-HALTS, the PLATO STEMI subanalysis, the two CHAMPIONs, and CASCADE and tackle the issue of too little, too soon in clinical trials today.
New agents and interventions are paving the way for revised modalities in the management of patients with atrial fibrillation. Join Drs Alpert and Delascio Lopes for a review of the latest findings and options.
Raised in a blue-collar neighborhood of Somerville, MA, Dr Bob Harrington was blessed to have a strong family and the Jesuits on his side as he traveled from "Yankee" Boston to Duke University. Join him as he tells his story to Dr Rob Califf.