The Curbsiders Internal Medicine Podcast #418 DIGEST (Tofurkey Edition): Semaglutide for HFpEF, TCAs for IBS, Aspirin vs Clopidogrel after PCI, Pitavastatin for HIV, Starchy Vegetables & Weight Gain, Heavy Metals in Cannabis
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Nov 27, 2023 
Drs. Paul Williams and Nora Taranto discuss semaglutide for HFpEF and obesity, TCAs for IBS, clopidogrel vs aspirin after PCI, pitavastatin in HIV, weight changes and diet, and heavy metal exposure in cannabis users.
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Choose TCAs To Address Multiple Symptoms
- When prescribing TCAs for IBS, pick patients who might gain extra benefit (insomnia, chronic pain, migraine) to 'kill two birds.'
- Counsel about anticholinergic effects and use low starting doses with titration.
Clopidogrel Better Than Aspirin After DAPT
- HOST-EXAM randomized >55,000 patients to clopidogrel vs aspirin monotherapy after 6–18 months of DAPT post-PCI.
- Clopidogrel reduced the composite of death, MI, stroke, ACS readmission, or major bleeding versus aspirin.
Benefit Of Clopidogrel Holds Across Risk Strata
- A HOST-EXAM post-hoc stratified analysis found clopidogrel's benefit consistent across ischemic and bleeding risk strata.
- Clopidogrel was associated with fewer hemorrhagic strokes than aspirin in high-risk groups.