Aspirin plus PPI safer than clopidogrel if there is history of GI bleeding

Q&A

J Fam Pract. 2005 April;54(4):303-309

Clinical Question: What is the best antithrombotic for patients with a history of upper gastrointestinal bleeding?
Study Design: Randomized controlled trial (double-blinded)
Allocation: Concealed
Setting: Inpatient (any location) with outpatient follow-up
Synopsis: Clopidogrel has been recommended by the American College of Cardiology as the preferred drug for patients who require an antithrombotic agent to prevent heart disease but who also have a history of bleeding peptic ulcer. This study compared clopidogrel with the combination of aspirin and esomeprazole in this setting. Patients with a source of upper gastrointestinal bleeding (52% gastric ulcer, 34% duodenal ulcer, 8% both, 6% other erosions) who had healing confirmed by endoscopy were randomized to clopidogrel 75 mg daily plus esomeprazole placebo twice daily or aspirin 80 mg daily plus esomeprazole 20 mg twice daily. Groups were fairly well balanced at the outset, allocation was concealed, and analysis was by intention to treat.

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