JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT Tuesday, March 3, 2009)
JAMA NEWS RELEASES
Combined Use of Antiplatelet, Gastric Acid Medications Following Heart Attack or Angina Associated With Increased Risk of Death, Hospitalization
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
STUDY FINDS TWO MEDICINES PRESCRIBED TOGETHER AFTER A HEART ATTACK MAY INCREASE THE RISK OF ANOTHER CARDIAC EVENT
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
Please Note: There are two JAMA Reports for the week of March 2, with different embargo times and satellite coordinates.
Monday, March 2 (early embargo of 11 a.m. ET, March 2): This JAMA report video is on a growing resistance to a commonly used anti-viral agent for influenza A. The report will be fed Monday, March 2, from 9:00 - 9:30 a.m. ET, and 2:00 - 2:30 p.m. ET, on Analog AMC3: Transponder 3, C-band, downlink frequency: 3760 H, audio 6.2/6.8.
Tuesday, March 3 (embargo of 3 p.m. CT, March 3): This JAMA Report video is on the risk of harmful outcomes by combining certain medications following a heart attack or angina. The report will be fed Tuesday, March 3, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 28 (C-Band), Transponder 19, downlink frequency: 4080 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
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Go to www.jamamedia.org for more information and to apply for access.
Embargoed for Release: 3:00 p.m. CT, Tuesday, March 3, 2009
Media Advisory: To contact P. Michael Ho, M.D., Ph.D., call Christina White at 303-393-5205 or email christina.white{at}va.gov.
Combined Use of Antiplatelet, Gastric Acid Medications Following Heart Attack or Angina Associated With Increased Risk of Death, Hospitalization
CHICAGO—Following an acute coronary syndrome such as a heart attack or unstable angina, patients who receive a medication to reduce the risk of gastrointestinal bleeding that may be associated with the use of the antiplatelet drug clopidogrel and aspirin have an increased risk of subsequent hospitalization for acute coronary syndrome or death, according to a study in the March 4 issue of JAMA.
Treatment with clopidogrel in addition to aspirin reduces recurrent cardiovascular events following hospitalization for acute coronary syndrome (ACS) for patients treated either medically or with angioplasty or stent placement. Proton pump inhibitor (PPI) medications are often prescribed at the start of treatment with clopidogrel, with the goal of reducing the risk of gastrointestinal tract bleeding while patients are taking dual-antiplatelet therapy. Recent studies, however, suggest that PPIs may reduce the effectiveness of clopidogrel, but the clinical significance of these findings to patients is not clear, according to background information in the article.
P. Michael Ho, M.D., Ph.D., of the Denver VA Medical Center, and colleagues evaluated the use of clopidogrel plus PPI following hospital discharge for ACS and compared rates of all-cause death and rehospitalization for ACS, between patients taking clopidogrel plus PPI vs. clopidogrel without PPI. The study included patients from 127 Veterans Affairs hospitals. Vital status information was available for all patients through September 30, 2006.
Of 8,205 patients with ACS taking clopidogrel after hospital discharge, 63.9 percent (n = 5,244) were prescribed PPI at discharge or during follow-up. Death or rehospitalization for ACS occurred in 29.8 percent of patients prescribed clopidogrel plus PPI and 20.8 percent of patients prescribed clopidogrel without PPI . Use of clopidogrel plus PPI at any point in time was associated with a 25 percent increased odds of death or rehospitalization for ACS compared with use of clopidogrel without PPI.
For the individual outcomes, the rates of recurrent hospitalization for ACS (14.6 percent vs. 6.9 percent) and revascularization procedures (15.5 percent vs. 11.9 percent) were higher among patients taking clopidogrel plus PPI compared with those taking clopidogrel without PPI. However, the risk of death was similar between the two groups.
"When patients were not taking clopidogrel after hospital discharge, a prescription for PPI was not associated with death or rehospitalization for ACS, supporting the hypothesis that the interaction of PPI and clopidogrel, rather than PPI itself, was associated with increased adverse outcomes," the authors write.
"...this study raises some concern about concomitant [accompanying] use of PPI medications and clopidogrel following hospitalization for ACS. While the risk estimates associated with clopidogrel plus PPI vs. clopidogrel without PPI were modest, the absolute number of adverse events attributable to this potential drug interaction is considerable when extrapolated to a population level, given how frequently PPI medications are prescribed to patients receiving dual-antiplatelet therapy," the researchers write. "Pending additional evidence, however, the results of this study may suggest that PPIs should be used for patients with a clear indication for the medication, such as history of gastrointestinal tract bleeding, consistent with current guideline recommendations, rather than routine prophylactic prescription. Alternative gastrointestinal tract medication regimens also may be considered until additional data regarding concomitant use of PPI and clopidogrel becomes available."
(JAMA. 2009;301[9]:937-944. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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JAMA REPORTS
VIDEO:
Windows Media |
Quicktime
STUDY FINDS TWO MEDICINES PRESCRIBED TOGETHER AFTER A HEART ATTACK MAY INCREASE THE RISK OF ANOTHER CARDIAC EVENT
INTRO:
Heart disease kills more Americans annually than any other illness. Now new research shows that a certain combination of medicines commonly given to those who survive a heart attack may actually be doing more harm than good. Haley Weldon explains in this week's JAMA Report.
VIDEO:
B-ROLL
Dr. Ho w/patient
AUDIO:
VO: (:06)
AFTER SURVIVING A HEART ATTACK, MANY PATIENTS ARE GIVEN SPECIFIC MEDICATIONS IN AN ATTEMPT TO PREVENT ANOTHER ONE.
VIDEO:
SOT/FULL
John S. Rumsfeld, M.D., Ph.D.
Denver VA Medical Center
AUDIO:
Runs: :11
We very often prescribe both clopidogrel, which is a blood thinning medication, sort of like a super-aspirin, along with drugs that protect the stomach...
VIDEO:
SOT/FULL
Thomas M. Maddox, M.D., M.Sc.
Denver VA Medical Center
AUDIO:
Runs: 07
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.
VIDEO:
B-ROLL
Hospital B-roll,
Dr. Ho w/ patient
AUDIO:
VO: (:08)
WHILE THE BENEFITS OF CLOPIDOGREL ARE WELL RECOGNIZED, RECENT STUDIES HAVE RAISED QUESTIONS ABOUT HOW PPIS INTERACT WITH IT.
VIDEO:
SOT/FULL
P. Michael Ho, M.D., Ph.D.
Denver VA Medical Center
AUDIO:
Runs: :11
There was a suggestion from these platelet studies that the Clopidogrel didn’t work as well in these patients that were also taking proton pump inhibitors.
VIDEO:
B-ROLL
Dr. Ho walking down hallway
Dr. Ho at computer
GFX/FULL PAGE BUILD:
PATIENTS STUDIED
* 8,205 Veterans
* Suffered Acute Coronary Syndrome (Heart Attack or Unstable Angina)
* Discharged on Clopidogrel
AUDIO:
VO: (:15)
TO BETTER UNDERSTAND THIS INTERACTION, DR. MICHAEL HO OF THE DENVER VA MEDICAL CENTER, AND HIS COLLEAGUES, STUDIED THE OUTCOMES OF OVER 8,000 PATIENTS WHO HAD AN ACUTE CORONARY SYNDROME AND WERE PRESCRIBED CLOPIDOGREL AT THE TIME OF HOSPITAL DISCHARGE.
VIDEO:
SOT/FULL
P. Michael Ho, M.D., Ph.D.
Denver VA Medical Center
AUDIO:
Runs: :18
We found that in patients who were taking Clopidogrel and a proton pump inhibitor medication compared to those who were only taking Clopidogrel alone, had a, about a 25% increased risk of having another heart attack or dying following the hospitalization.
VIDEO:
GFX/FULL PAGE
JAMA COVER
GFX/FULL PAGE
MEDICINE TAKEN BY PATIENTS IN STUDY
Clopidogrel with PPI: 5,244 Patients (63.9%)
Clopidogrel only: 2,961 Patients (36.1%)
B-ROLL
Docs/nurses in hospital
AUDIO:
VO: (:13)
ACCORDING TO THE STUDY, WHICH APPEARS THIS WEEK IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, NEARLY 2/3RDS OF THE PATIENTS OBSERVED WERE TAKING CLOPIDOGREL AND A PPI MEDICINE TOGETHER, WHICH NOW MIGHT NOT BE CONSIDERED THE BEST COURSE OF TREATMENT.
VIDEO:
SOT/FULL
P. Michael Ho, M.D., Ph.D.
Denver VA Medical Center
AUDIO:
Runs: :11
Our study findings don’t alter the recommendations given for clopidogrel use after patients have a heart attack or after they receive a coronary artery stent.
VIDEO:
SOT/FULL
John S. Rumsfeld, M.D., Ph.D.
Denver VA Medical Center
AUDIO:
Runs: 16
It suggests to us that if a given patient is going to get clopidogrel after a heart attack which the guidelines strongly recommend, that you should only give them a PPI medication if they have a very strong compelling reason for it.
VIDEO:
B-ROLL
Dr. Ho with patient
AUDIO:
VO: (:06)
IMPORTANT INFORMATION THAT MAY AFFECT THE CLINICAL CARE OF THE MANY HEART ATTACK SURVIVORS. HALEY WELDON, THE JAMA REPORT.
