Key result
The combination of low-dose enteric coated aspirin and clopidogrel significantly increased the rate of gastrointestinal bleeding to 9.4% compared to 2.4% in the control group (p=0.048).
Why the study?
Does low-dose enteric coated aspirin with or without clopidogrel increase gastrointestinal bleeding and gastroduodenal mucosal injury in patients with coronary artery disease?
Cohort (n=387)
No
Does low-dose enteric coated aspirin with or without clopidogrel increase gastrointestinal bleeding and gastroduodenal mucosal injury in patients with coronary artery disease?
Dual antiplatelet therapy with aspirin and clopidogrel significantly increases the risk of gastrointestinal bleeding and mucosal injury compared to control in CAD patients, particularly in older patients with multiple comorbidities.
DAPT was associated with higher GI bleeding in CAD; leaves open optimal gastroprotection strategies for prospective trials.
BACKGROUND/AIMS: This study was performed to determine whether low-dose aspirin and/or clopidogrel can induce gastrointestinal bleeding and gastroduodenal mucosal injury. METHODS: A total of 387 patients who underwent coronary angiography at Seoul National University Bundang Hospital were assigned to one of three antiplatelet treatment groups: (1) control, (2) 100-mg enteric coated aspirin, and (3) 100-mg enteric coated aspirin plus clopidogrel. The incidences of gastroduodenal mucosal injury and gastrointestinal bleeding were prospectively evaluated, and risk factors for gastrointestinal bleeding were analyzed. RESULTS: for gastrointestinal bleeding were analyzed. RESULTS: The rate of gastroduodenal mucosal injury was higher in the aspirin-plus-clopidogrel group than in the aspirin group (p=0.012), and higher in the aspirin group than in the control group (p=0.049). The rate of gastrointestinal bleeding was significantly higher in the aspirin-plus-clopidogrel group (9.4%) than in the control group (2.4%, p=0.048). The risk factors for gastrointestinal bleeding were older age (>/=60 years) and the presence of at least two comorbid disorders. CONCLUSIONS: Low-dose enteric coated aspirin was found to be safe in patients with coronary artery disease, but the addition of clopidogrel increased the rate of gastrointestinal bleeding. Combined clopidogrel and aspirin should be used with caution in older patients having at least two comorbid conditions.
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Choi et al. (2008) conducted a cohort in Coronary artery disease (n=387). Low-dose enteric coated aspirin (100 mg/day) plus clopidogrel (75 mg/day) vs. Control (no antiplatelet therapy) was evaluated on Gastrointestinal bleeding (p=0.048). The combination of low-dose enteric coated aspirin and clopidogrel significantly increased the rate of gastrointestinal bleeding to 9.4% compared to 2.4% in the control group (p=0.048).
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