Gastrointestinal bleeding clopidogrel

The manufacturers of clopidogrel warn about possible gastrointestinal bleeding if it is used with naproxen or other NSAIDs. There is also an increased risk of bleeding if ticlopidine is given with NSAIDs. 

Due to the lack of interaction studies with other NSAIDs, it is unclear whether there is an increased risk of gastrointestinal bleeding with all NSAIDs. The manufacturers advise caution if NSAIDs and clopidogrel are given together. ... 

Gastrointestinal There was an increased risk of major gastrointestinal bleeding, but not other major or minor bleeding events, in the year after percutaneous coronary intervention in 1816 patients in whom clopidogrel or placebo was added to aspirin after 4 weeks [163 ]. 

Lin C-C, Hu H-Y, Luo J-C, Peng Y-L, Hou M-C, Lin H-C, et al. Risk factors of gastrointestinal bleeding in clopidogrel users a nationwide population-based study. Aliment Pharmacol Ther 2013 38(9) 1119-28. 

In addition to the risk of bleeding, which will be detailed in the different studies, thienopyridines are able to cause skin disorders (rashes or prurit) and gastrointestinal disorders (diarrhea). In the CLASSICS study, these side effects were observed in 8.2% of patients treated with ticlopidine and in 3.5% of those taking clopidogrel treatment. The most serious problem was related to hematologic disorders neutropenia or thrombocytopenia. These disorders are much less frequent with clopidogrel than with ticlopidine 0.04% of neutropenia in the CAPRIE study and 0.05% in the CURE trial, Thrombotic thrombocytopenic purpura are exceptional one for 200,000 patients. 

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