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Upper gastrointestinal lesions in patients receiving clopidogrel anti-platelet therapy
Tzung-Jiun Tsai1, Kwok-Hung Lai, Ping-I Hsu
1Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Insights
Symptomatic clopidogrel users experience more upper gastrointestinal issues like hemorrhagic spots and peptic ulcers compared to aspirin users. Most peptic ulcers in clopidogrel patients are found in the stomach.
Area of Science:
- Gastroenterology
- Pharmacology
Background:
- Clopidogrel use is linked to increased upper gastrointestinal bleeding.
- Understanding specific gastrointestinal lesions in symptomatic clopidogrel users is crucial.
Purpose of the Study:
- To characterize endoscopic findings in clopidogrel users with upper gastrointestinal symptoms.
- To compare clinical features and lesions between clopidogrel and aspirin users.
Main Methods:
- Observational study of 215 patients with dyspeptic symptoms on clopidogrel or aspirin.
- Endoscopic assessment of upper gastrointestinal lesions and medical history collection.
Main Results:
- Clopidogrel users showed higher frequencies of hemorrhagic spots (25%) and peptic ulcers (39%) than aspirin users.
- Peptic ulcers in clopidogrel users were predominantly gastric (78%).
- Clopidogrel users were older, with more prior ulcer/GI bleeding history, but less H. pylori infection.
Conclusions:
- Symptomatic clopidogrel users exhibit a higher incidence of hemorrhagic spots and peptic ulcers than aspirin users.
- Gastric location is most common for peptic ulcers in clopidogrel users.
Background/Purpose:
Clopidogrel is associated with a high incidence of upper gastrointestinal bleeding in high-risk patients. However, the characteristic upper gastrointestinal lesions in symptomatic clopidogrel users remain unclear. The aims of this study were to investigate the characteristics of endoscopic findings in clopidogrel users undergoing endoscopy for upper gastrointestinal symptoms and to compare the clinical characteristics and upper gastrointestinal lesions between symptomatic clopidogrel and aspirin users.
Methods:
This observational study included 215 consecutive patients receiving clopidogrel (n=106) or low-dose aspirin (n=109) therapy who underwent endoscopy for dyspeptic symptoms. The upper gastrointestinal lesions were carefully assessed, and a complete medical history was obtained by a standard questionnaire.
Results:
The frequencies of hemorrhagic spots, erosions and peptic ulcers in the symptomatic clopidogrel users were 25%, 39% and 39%, respectively. Among the peptic ulcer patients on clopidogrel therapy, the distributions of ulcers were 78%, 5% and 17% in the stomach, duodenum and both, respectively. Compared with the aspirin group, the clopidogrel group was older and had higher frequencies of past ulcer history and past gastrointestinal bleeding history in their clinical characteristics. By contrast, the clopidogrel users had a lower prevalence of active Helicobacter pylori infection than aspirin users (17% vs. 35%, respectively, p=0.007). Regarding to the endoscopic findings, the clopidogrel users had higher frequencies of hemorrhagic spots (25% vs. 10%) and peptic ulcer (39% vs. 24%) than aspirin users (p=0.004 and 0.027, respectively).
Conclusion:
Most peptic ulcers in clopidogrel users are located in the stomach. The frequencies of hemorrhagic spots and peptic ulcers in symptomatic clopidogrel users are higher than those in symptomatic aspirin users.
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