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Risk of massive upper gastrointestinal bleeding in gastric bypass patients taking clopidogrel
Joseph A Caruana1, Marc N McCabe, Audrey D Smith
1Department of Surgery, Sisters of Charity Hospital, Buffalo, New York, USA.
Insights
Patients undergoing gastric bypass surgery face a high risk of upper gastrointestinal bleeding when taking clopidogrel (Plavix). Discontinuation of the antiplatelet drug and proton pump inhibitors effectively stopped bleeding in a study group.
Area of Science:
- Gastroenterology
- Cardiology
- Bariatric Surgery
Background:
- Clopidogrel (Plavix) is a common antiplatelet medication for patients with coronary stents or stroke history.
- Morbid obesity is linked to atherosclerosis, making some patients candidates for weight loss surgery.
- Weight loss surgery, specifically gastric bypass, is increasingly performed in patients on clopidogrel.
Purpose of the Study:
- To assess the risk of upper gastrointestinal bleeding in patients taking clopidogrel after gastric bypass surgery.
Main Methods:
- Retrospective review of patients who underwent gastric bypass and were taking clopidogrel.
- Focus on patients experiencing upper gastrointestinal bleeding requiring hospitalization and transfusion.
- Emergency endoscopy was performed on all bleeding patients.
Main Results:
- Four out of 11 (36%) patients on clopidogrel developed significant upper gastrointestinal bleeding post-gastric bypass.
- Bleeding occurred between 25 and 234 days after surgery.
- All cases resolved with clopidogrel discontinuation and intravenous proton pump inhibitor therapy.
Conclusions:
- Gastric bypass patients on clopidogrel exhibit a high risk for gastrointestinal bleeding complications.
- Proton pump inhibitors, such as omeprazole, may be beneficial as a prophylactic measure when clopidogrel is essential.
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.
Conclusion:
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.
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