Key result
Dual antiplatelet therapy significantly exacerbated the risk of small bowel ulcers compared to other antithrombotic regimens (OR 3.0) in patients with obscure gastrointestinal bleeding.
Why the study?
Antithrombotic drugs are increasingly used to prevent cardiovascular diseases, but few studies have evaluated small bowel mucosal injury induced by dual antiplatelet therapy compared with other antithrombotics.
Does dual antiplatelet therapy exacerbate small bowel mucosal injury compared to other antithrombotic regimens in patients with obscure gastrointestinal bleeding?
Observational (n=183)
No
Does dual antiplatelet therapy exacerbate small bowel mucosal injury compared to other antithrombotic regimens in patients with obscure gastrointestinal bleeding?
Dual antiplatelet therapy significantly exacerbates low-dose aspirin-induced small bowel mucosal injury, highlighting the need for preventive gastrointestinal strategies in these patients.
Objective Antithrombotic drugs are being used increasingly frequently to prevent cardiovascular diseases. Few studies have evaluated small bowel mucosal injury induced by dual antiplatelet therapy (DAPT). The aim of the present study was to evaluate small bowel mucosal injury induced by DAPT compared with other antithrombotics using video capsule endoscopy (VCE). Methods The study included chronic users of antithrombotics who underwent VCE for obscure gastrointestinal bleeding between January 2007 and July 2018. We evaluated the instances of small bowel injury classified into erosions and ulcers. Results Overall, 183 patients (114 men and 69 women; mean age, 73.6 years old) were enrolled, and the study groups comprised 49 patients taking low-dose aspirin (LDA) only, 50 taking anticoagulants only, 37 being treated with DAPT, 33 on combined LDA and anticoagulants, and 14 taking P2Y12 inhibitors. Small bowel erosions and ulcers were most frequently observed in the DAPT group, with frequencies of 78.4% and 37.8%, respectively. Exacerbating factors of small bowel ulcers were DAPT [odds ratio (OR) 3.0, 95% confidence interval (CI) 1.2-7.7] and age over 80 years old (OR 2.4, 95% CI 1.1-5.4). Conclusion P2Y12 inhibitors seem to exacerbate LDA-induced small bowel injury. Preventive strategies for small bowel injury induced by LDA, especially DAPT, are urgently required.
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Handa et al. (2021) conducted an observational in Obscure gastrointestinal bleeding (n=183). Dual antiplatelet therapy (DAPT) vs. Other antithrombotic regimens (LDA alone, anticoagulants alone, LDA+anticoagulants, P2Y12 inhibitors alone) was evaluated on Small bowel ulcers (OR 3.0, 95% CI 1.2-7.7, p=0.024). Dual antiplatelet therapy significantly exacerbated the risk of small bowel ulcers compared to other antithrombotic regimens (OR 3.0) in patients with obscure gastrointestinal bleeding.
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