Risk of massive upper gastrointestinal bleeding in gastric bypass patients taking clopidogrel.
BACKGROUND
The antiplatelet drug clopidogrel (Plavix) is widely used in patients who have undergone coronary artery stenting or had a stroke. Because morbid obesity is associated with atherosclerosis, some of these patients are candidates for weight loss surgery. We chose to determine the risk of upper gastrointestinal bleeding after gastric bypass in patients taking clopidogrel.


METHODS
Patients who took clopidogrel after gastric bypass were identified by specific review of the subset of patients who had had upper gastrointestinal bleeding requiring hospital admission and transfusion. All who bled underwent emergency endoscopy.


RESULTS
Of 11 patients taking clopidogrel, 4 (36%) presented with significant upper gastrointestinal bleeding 25-234 days after gastric bypass. All stopped bleeding with discontinuation of the drug and treatment with an intravenous proton pump inhibitor.


CONCLUSIONS
Gastric bypass patients appear to be at high risk of bleeding complications when taking clopidogrel. On the basis of the available published data from another high-risk group (i.e., those with a history of peptic ulcer disease), co-treatment with omeprazole may be indicated when clopidogrel must be continued.
Caruana
Joseph A
JA
Department of Surgery, Sisters of Charity Hospital, Buffalo, New York, USA.
McCabe
Marc N
MN
Smith
Audrey D
AD
Panemanglore
Vishnudas Pai
VP
Sette Camara
Daniel
D
D000328:Adult; D000077144:Clopidogrel; D016099:Endoscopy, Gastrointestinal; D005260:Female; D015390:Gastric Bypass; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine