Summary

Original source:
http://www.sciencedaily.com/releases/2005/01/050124004939.htm

Details

• Heart patients with gastrointestinal complications should use low doses of aspirin combined with drugs that treat stomach ulcers rather than taking the anti-platelet drug Plavix, which has been thought to reduce bleeding ulcers, according to a gastroenterologist at UT Southwestern Medical Center and the Dallas Veterans Affairs Medical Center.
• Physicians are challenged in treating heart patients who may be at high-risk for gastrointestinal bleeding from aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs).
• Factors that place patients at high-risk include a history of ulcers or gastrointestinal complications such as bleeding, increased age and congestive heart failure.
• In an editorial in the current issue of The New England Journal of Medicine, Dr. Byron Cryer, associate professor of internal medicine at UT Southwestern, said current cardiology guidelines suggest patients who cannot take aspirin because of previous bleeding ulcers be given the drug clopidogrel (Plavix), which has been found to be marginally better than low-dose aspirin in preventing heart attacks and reducing bleeding ulcers.
• But, Plavix's effectiveness has not been proven in heart patients at greatest risk due to their history of gastrointestinal bleeding, and recent research indicates it actually may impair ulcer healing and markedly increase rates of bleeding.
• "Clopidogrel inhibits new growth of small blood vessels in ulcers - which is important for ulcer healing," said Dr. Cryer, a VA physician.
• When combined with the propensity to increase bleeding, these agents may convert small, silent ulcers into large ulcers that bleed profoundly."
• Consequently, Dr. Cryer recommends that patients at high-risk for gastrointestinal complications who require blood clot-preventing therapy should consume the lowest effective dose of aspirin combined with drugs used to treat stomach ulcers (such as Aciphex, Nexium, Prevacid, Prilosec or Protonix) rather than take clopidogrel.

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