January 16th, 2009

Beware of Plavix: Your Next On-Call Nightmare

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.


3 Responses to “Beware of Plavix: Your Next On-Call Nightmare”

  1. Bahman N Shokouhi says:

    A recent article in the Canadian Medical Association Journal (published online Jan 28, 2009), suggests that this is not a class effect and that Pantoprazole does not seem to have an effect. It has been suggested that the cause of this is the effect of most PPIs on P450 2C19. Pantoprazole does not affect P450 2C19 and therefore according to the data does not reduce the effectiveness of clopidogrel. So, hopefully if we start using Pantoprazole instead of Omeprazole and other PPIs you can still continue with your calls!

  2. […] but maybe an easy solution! Posted by M. Brian Fennerty on February 5th, 2009 In response to my earlier post on PPIs and upper GI bleeding, Bahman N Shokouhi writes: A recent article in the Canadian Medical Association Journal (published […]

  3. judy says:

    every heart beat hurts like fire, What is wrong

Gastroenterology Research: Author M. Brian Fennerty, M.D.

M. Brian Fennerty, MD


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