Magnetically Controlled Capsule Endoscopy for Assessment of Antiplatelet Therapy-Induced Gastrointestinal Injury

Area of Science:

• Gastroenterology
• Cardiology
• Pharmacology

Background:

• Gastrointestinal bleeding is a primary complication of antiplatelet therapy.
• Overt gastrointestinal bleeding is uncommon in low-risk patients.
• Assessing antiplatelet regimens' impact on gastrointestinal mucosal injury is crucial.

Purpose of the Study:

• To evaluate the effects of different antiplatelet regimens on gastrointestinal mucosal injury.
• To compare single antiplatelet therapy (SAPT) versus dual antiplatelet therapy (DAPT) in low-risk patients.
• To utilize a novel magnetically controlled capsule endoscopy system for precise injury assessment.

Main Methods:

• 505 patients undergoing percutaneous coronary intervention were initially on DAPT for 6 months.
• Patients with no ulcerations/bleeding (erosions permitted) were randomized to aspirin, clopidogrel, or DAPT for another 6 months.
• Capsule endoscopy assessed gastrointestinal mucosal injury (erosions, ulceration, bleeding) at 6 and 12 months.

Main Results:

• Gastrointestinal mucosal injury was less frequent with SAPT versus DAPT over 12 months (94.3% vs 99.2%, P=0.02).
• In patients without baseline injury, SAPT showed significantly less injury (68.1% vs 95.2%, P=0.006) and fewer new ulcers (8.5% vs 38.1%, P=0.009) compared to DAPT.
• Clinical gastrointestinal bleeding was substantially lower with SAPT (0.6% vs 5.4%, P=0.001).

Conclusions:

• Nearly all patients on antiplatelet therapy experienced gastrointestinal injury, despite low bleeding risk.
• DAPT followed by SAPT (aspirin or clopidogrel) for 6-12 months reduced gastrointestinal injury and bleeding compared to continuous DAPT.
• The OPT-PEACE study (NCT03198741) demonstrates the benefit of SAPT in mitigating antiplatelet-related gastrointestinal harm.