Dual antiplatelet therapy was associated with higher gastric mucosal injury (m-Lanza score 1.67) than clopidogrel alone (0.72, p=0.03) and tended to be higher than aspirin alone (0.95, p=0.06).
Observational
Does dual antiplatelet therapy increase the degree of gastric mucosal injury compared to single antiplatelet therapy in patients undergoing esophagogastroduodenoscopy?
Dual antiplatelet therapy with aspirin and clopidogrel is associated with a higher degree of gastric mucosal injury compared to single antiplatelet therapy in real-world clinical practice.
p-value: p=0.06 vs aspirin, 0.03 vs clopidogrel
Background: Patients taking low-dose aspirin have a higher incidence of gastroduodenal ulcers and higher risk of upper gastrointestinal bleeding than patients who do not. Thienopyridine antiplatelet agents may similarly cause bleeding gastroduodenal erosions and ulcers. The incidence of gastrointestinal bleeding is reported to be higher when these antithrombotic drugs are used in combination. Until now, most studies have focused on bleeding, and no study has compared the degree of gastric mucosal injury between patients receiving dual antiplatelet therapy (DAPT) and those receiving single antiplatelet therapy (SAPT) in real-world clinical practice. Aim: Our objective was to compare the degree of gastric mucosal injury in patients taking low-dose aspirin in combination with clopidogrel (one of the thienopyridine antiplatelet agents) with that of patients who were taking aspirin or clopidogrel as a single agent. Methods: Patients who were taking aspirin and/or clopidogrel and who underwent scheduled esophagogastroduodenoscopy between April 2015 and March 2020 were enrolled in this study. Endoscopic images were reviewed retrospectively, and the degree of gastric mucosal injury was assessed with the modified Lanza score (m-Lanza score). The m-Lanza score was compared between DAPT patients taking aspirin and clopidogrel and SAPT patients taking either aspirin alone or clopidogrel alone. Results: The m-Lanza scores of the DAPT group, the aspirin group, and the clopidogrel group were 1.67 ± 1.81 (mean ± standard deviation), 0.95 ± 1.61, and 0.72 ± 1.29, respectively. The m-Lanza score of the DAPT group tended to be higher than that of the aspirin group (p = 0.06) and was significantly higher than that of the clopidogrel group (p = 0.03). Conclusion: The degree of gastric mucosal injury in DAPT patients was significantly higher than that in patients using clopidogrel alone and tended to be higher than that in patients using aspirin alone in real-world clinical practice.
Shimada et al. (Thu,) conducted a observational in Gastric mucosal injury in patients on antiplatelet therapy. Dual antiplatelet therapy (aspirin and clopidogrel) vs. Single antiplatelet therapy (aspirin alone or clopidogrel alone) was evaluated on Degree of gastric mucosal injury assessed by the modified Lanza score (m-Lanza score) (p=0.06 vs aspirin, 0.03 vs clopidogrel). Dual antiplatelet therapy was associated with higher gastric mucosal injury (m-Lanza score 1.67) than clopidogrel alone (0.72, p=0.03) and tended to be higher than aspirin alone (0.95, p=0.06).