Patients with peptic ulcers

doi:10.1136/bmj.b1932

Published 20 May 2009, doi:10.1136/bmj.b1932
Cite this as: BMJ 2009;338:b1932

Letters

Clopidogrel

Patients with peptic ulcers

The first 150 words of the full text of this article appear below.

Although the benefits of primary prevention of gastrointestinalbleeding with a proton pump inhibitor in all patients takingaspirin and clopidogrel are questionable, Chua and Ignaszewskishould have emphasised the importance of a history of pepticulcer as a risk factor for recurrent bleeding while receivingantiplatelet treatment (odds ratio 10.6 to 16).¹ ² These patientsdo require acid suppressive treatment.

Although H₂ receptor antagonists do not affect CYP2C19, it remainsto be proved that they reduce clinically important end pointsin these high risk patients. Double dose ranitidine and famotidinereduce endoscopically detectable ulcers induced by non-steroidalanti-inflammatory drugs but have not been shown to reduce ulcercomplications.³ Concomitant treatment with proton pump inhibitorreduced the excess risk of bleeding associated with all antiplatelettreatments, but H₂ antagonists were effective without any dose-responserelation.²