Clopidogrel, Omeprazole, and Upper GI Bleeding

A complex interaction exists between antiplatelet agents, PPIs, upper GI bleeding, and adverse cardiac events. This study provides data but not the answer to the puzzle.

Recent data have suggested that gastrointestinal bleeding that is attributable to antiplatelet therapy is a relatively common event following percutaneous coronary intervention (PCI) and coronary artery stenting (Journal Watch Gastroenterology Jan 4 2008). When patients received proton-pump inhibitors (PPIs) concurrently with aspirin and powerful antiplatelet agents (such as clopidogrel) that are prescribed routinely after PCI, post-PCI bleeding occurred less commonly than when PPIs were not taken. However, clopidogrel is a prodrug that requires oxidation by the hepatic CYP system to generate the active metabolite. The degree of metabolic activity of CYP3A4, the dominant metabolic pathway for clopidogrel conversion, has been associated with…

Reviewing Author

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors