Gut Check

I love being a gastroenterologist, but I hate being on call. If I could avoid “call,” I probably would never even contemplate retiring. Alas, call may be about to get worse for gastroenterologists, especially in light of new evidence that could curtail the common use of PPIs to prevent GI bleeding in patients taking clopidogrel (Plavix).

Clopidogrel, a life-saving antiplatelet drug prescribed for a widening variety of cardiovascular indications, is associated with increased risk for GI bleeding – one of our most common on-call calls. To reduce the incidence of clopidogrel-induced bleeding, PPIs such as omeprazole (Prilosec) are often prescribed, since these agents reduce the prevalence of ulcers and erosions, which tend to bleed more in patients taking clopidogrel.

Why the concern about PPIs? Well emerging data show that although omeprazole protects patients against clopidogrel’s adverse GI effects, it might also negate clopidogrel’s cardiac protection. If patients taking clopidogrel are told to avoid PPIs, we might soon see a marked rise in cases of clopidogrel-related GI bleeding during our nights and days on call. If you have thoughts on this issue or on how best to manage patients if the above scenario comes to pass, please let me know.