If you’re one of the 50 million Americans taking an aspirin a day to prevent heart attack and stroke, you might be at risk for developing stomach ulcer bleeding. The current recommendations are that doctors give patients at risk for a bleeding ulcer the drug Plavix instead of aspirin. Alternatively doctors are going ahead and giving patients aspirin but also prescribing an acid reducing medicine to prevent the formation of stomach ulcers.

Dr. James Marion, a gastroenterologist at Mt. Sinai Medical Center says, “Well there always has been a debate. The joke on the wards is that the heart trumps the gut, meaning the heart is much more important than the gut. Now as a gastroenterologist I’m always a little offended by that.”
He might be offended, but the statement goes to the core of the concern--an aspirin a day helps keep the cardiologist away because of its blood thinning properties. But aspirin and stomach ulcers are directly linked, and thinner blood means the ulcers are more likely to bleed.
Just ask Linda Andruszkiewicz, who ended up with severe abdominal pain. “I was basically just self-medicating myself with aspirin for headaches and muscle pain. Then it caught up with me and I started having abdominal pain. I knew instinctively that it was probably ulcers,” says Linda.
“Traditionally if someone has a high risk of having ulcers, we would avoid medicines like aspirin and favor a medicine like Plavix. In fact the recommendations of the American Heart Association are just that,” states Dr. Marion.
The newest study in Thursday’s New England Journal of Medicine shows that this newer medicine for cardiovascular disease, called Plavix, is no safer in terms of reduced risk of a bleed in the stomach compared to aspirin therapy along with another medicine. In fact aspirin and the latest purple pill, Esomeprazole, or Nexium, appears to be much safer and better tolerated than Plavix alone.
“This study obviously changes our thinking,” Dr. Marion believes.
The research was done on patients who had bleeding ulcers that had healed. Overall, almost 9% of those taking Plavix had another bleeding episode compared to less than
1% of those taking the aspirin and Nexium combination.
Interestingly Plavix also causes stomach irritation, although the drug works in a different way than aspirin. Previous research has shown that in healthy individuals Plavix causes less stomach irritation on endoscopy, and was just slightly more effective at preventing heart attacks.
However, in those who already have a significant gastrointestinal bleed, the aspirin-Nexium combination seems to be the way to go.
“I think the most important thing is for the doctors to recognize the high risk patients and make sure that they are getting the proper preventive like Nexium or Esomeprazole,” says Dr. Marion.

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