Gastrointestinal Events with Clopidogrel A Nationwide Population-Based Cohort Study
This article was used for a patient I presented for the second site evaluation.
HPI: 63 y/o Hispanic female with significant PMH of DM2, CKD stage 4, peripheral vascular disease, HTN, chronic ulcers on LE b/l, CAD, weakness & unsteady gait, prior hx of falls, was admitted to GH SNF for SAR on 1/28/19 from Beth Israel due to N/V x5days. In ED there was an isolated fever; emesis was non-bloody & nonbilious; labs showed stable electrolytes, no leukocytosis but there was neutrophilia; UA negative; elevated alk phos, which was elevated in the past but not to this degree; RUQ sono was benign. Her symptoms resolved without intervention. Pt was dx of vital gastroenteritis & dehydrated. During admission, pt had elevated BUN & Cr, may be due to pt’s CKD progression. Pt hospital stay was complicated by anemia due to possible GIB vs CKD, pt received 1unit of PRBC with good respond & stable after the intervention. Pt is DC off Plavix. After admission to GH, pt developed cough and SOB.
Based on the article, there is a high risk for gastrointestinal bleeding on patients who are on dual antiplatelet therapy (DAPT) of aspirin and plavix. In this case, the patient was on DAPT due to a Cath procedure with drug-eluting stents (DES) on 2016. The article highlights some key facts:
- Plavix (clopidogrel) compared to aspirin, has a higher risk for GI bleed
- Patient can discontinue DAPT after 12 months having the cath stent operation.
- Patient should continue with aspirin therapy even if he/she discontinues clopidogrel
- In order to decrease the incidence of GI bleed, prescribe proton pump inhibitors (i.e. omeprazole) as GI prophylaxis
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