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Upper gastrointestinal bleeding in patients with aspirin and clopidogrel co-therapy

Fook-Hong Ng1, Kwok-Fai Lam, Siu-Yin Wong

  • 1Department of Medicine and Surgery, Ruttonjee Hospital, Hong Kong, SAR, China. ngfhong@hkucc.hku.hk

Digestion
|June 26, 2008
PubMed

Insights

Upper gastrointestinal bleeding (UGIB) is a risk with aspirin and clopidogrel (A+C) therapy. Proton pump inhibitors (PPIs) significantly reduced this risk in a real-world study.

Area of Science:

  • Gastroenterology
  • Pharmacology
  • Clinical Medicine

Background:

  • Aspirin and clopidogrel (A+C) co-therapy is associated with upper gastrointestinal bleeding (UGIB).
  • Real-world data on UGIB occurrence and the efficacy of antisecretory agents during A+C co-therapy are limited.
  • Understanding these risks and protective measures is crucial for patient safety.

Purpose of the Study:

  • To determine the incidence of UGIB in patients receiving A+C co-therapy in a real-world setting.
  • To evaluate the effectiveness of H2-receptor antagonists (H2RA) and proton pump inhibitors (PPI) in preventing UGIB.
  • To provide evidence-based recommendations for managing gastrointestinal risks associated with dual antiplatelet therapy.

Main Methods:

  • A retrospective cohort study analyzing records of 987 patients on A+C co-therapy from January 2001 to September 2006.
  • Follow-up data collected until UGIB occurrence, cessation of A+C, change in antisecretory class, death, or March 2007.
  • Statistical analysis, including adjustment for relevant covariates, to compare UGIB risk between PPI, H2RA, and control groups.

Main Results:

  • The overall incidence of UGIB was 4.0% (39 out of 987 patients) after a median follow-up of 5.8 months.
  • H2RA use was associated with a marginally reduced risk of UGIB (OR = 0.43, p = 0.04).
  • PPI use demonstrated a significant reduction in UGIB risk compared to control (OR = 0.04, p = 0.002).

Conclusions:

  • The occurrence of UGIB in patients on A+C co-therapy is approximately 4.0% over a median of 5.8 months.
  • Co-prescription with proton pump inhibitors (PPIs) is associated with a significantly lower risk of UGIB.
  • These findings support the use of PPIs for gastrointestinal protection in patients undergoing A+C co-therapy.
Abstract

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