Comments on: Aspirin vs. Plavix after upper GI bleeding http://www.journalclub.org/2005/01/24/n49 Comments on the medical literature Wed, 13 Jul 2005 13:30:08 +0000 hourly 1 http://wordpress.org/?v=3.0.1 By: TLC http://www.journalclub.org/2005/01/24/n49/comment-page-1#comment-1454 TLC Thu, 31 Mar 2005 04:33:43 +0000 http://www.journalclub.org/2005/01/24/n49#comment-1454 I am outraged at such ludicrous implications that plavix causes gi bleed. 1. there was no arm where plavix was given with PPI 2. this was a small study 3. Plavix works on the adp receptor, ASA destroys the Prostaglandin protective layer of the stomach. 3. I cant believe the NEJM published this study. I am outraged at such ludicrous implications that plavix causes gi bleed.
1. there was no arm where plavix was given with PPI
2. this was a small study
3. Plavix works on the adp receptor, ASA destroys the Prostaglandin protective layer of the stomach.
3. I cant believe the NEJM published this study.

]]> By: mjmd http://www.journalclub.org/2005/01/24/n49/comment-page-1#comment-549 mjmd Mon, 31 Jan 2005 01:10:10 +0000 http://www.journalclub.org/2005/01/24/n49#comment-549 In response to the first comment: if I encounter a patient with upper GI bleeding on ASA, I would most likely switch to Plavix plus a PPI, not Plavix alone, although I admit there is no good data for this. I would just have a hard time continuing Aspirin with a history of recent UGI bleed, despite the results of this study. Of course everything depends on the specific clinical circumstances, as usual... In response to the first comment: if I encounter a patient with upper GI bleeding on ASA, I would most likely switch to Plavix plus a PPI, not Plavix alone, although I admit there is no good data for this. I would just have a hard time continuing Aspirin with a history of recent UGI bleed, despite the results of this study. Of course everything depends on the specific clinical circumstances, as usual…

]]> By: Pandrei http://www.journalclub.org/2005/01/24/n49/comment-page-1#comment-547 Pandrei Sun, 30 Jan 2005 22:31:27 +0000 http://www.journalclub.org/2005/01/24/n49#comment-547 I was similarly frustrated by this study. Another concern: How is the rate of lower GI bleeding the same in the two treatment arms? Aspirin has been shown to significantly increase the risk of lower GI bleeding, while clopidogrel (though with admittedly less extensive data) has not shown anywhere near the same degree of risk. My suspicion is that the study patients in both arms included a number of NSAID users--those in the esomeprazole arm would have been "protected" from upper but not lower GI bleeding. I was similarly frustrated by this study. Another concern: How is the rate of lower GI bleeding the same in the two treatment arms? Aspirin has been shown to significantly increase the risk of lower GI bleeding, while clopidogrel (though with admittedly less extensive data) has not shown anywhere near the same degree of risk. My suspicion is that the study patients in both arms included a number of NSAID users–those in the esomeprazole arm would have been “protected” from upper but not lower GI bleeding.

]]> By: madhousemadman http://www.journalclub.org/2005/01/24/n49/comment-page-1#comment-531 madhousemadman Tue, 25 Jan 2005 20:10:05 +0000 http://www.journalclub.org/2005/01/24/n49#comment-531 Well, I agree with you on the point concerning aspirin and PPI vs. clopidogrel alone and the fact that these comparisons are not fair. However, the current guidelines for patient who have bleeding complications with Aspirin calls for plavix ONLY therapy. So, did the study disprove that this is correct - I believe so. It is possible, nontheless, that plavix plus PPI is just as effective or maybe better than Aspirin plus PPI, but that remains to be seen. Unlike you, if I encounter another patient with UGI bleeding on ASA, my first intervention will no longer be switching to plavix. That is the point this article came to address. Well, I agree with you on the point concerning aspirin and PPI vs. clopidogrel alone and the fact that these comparisons are not fair. However, the current guidelines for patient who have bleeding complications with Aspirin calls for plavix ONLY therapy. So, did the study disprove that this is correct – I believe so.

It is possible, nontheless, that plavix plus PPI is just as effective or maybe better than Aspirin plus PPI, but that remains to be seen. Unlike you, if I encounter another patient with UGI bleeding on ASA, my first intervention will no longer be switching to plavix. That is the point this article came to address.

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