Alimmentary Tract

Journal of Gastroenterology

, Volume 43, Issue 9, pp 679-686

First online:

Management and outcome of peptic ulcers or erosions in patients receiving a combination of aspirin plus clopidogrel

  • Fook Hong NgAffiliated withDepartment of Medicine & Surgery, Ruttonjee Hospital
  • , Pierre ChanAffiliated withDepartment of Medicine, University of Hong Kong, Queen Mary Hospital
  • , Chi Pong KwanchingAffiliated withDepartment of Medicine, Princess Margaret Hospital
  • , Ching Kong LooAffiliated withDepartment of Medicine, Kwong Wah Hospital
  • , Ting Kin CheungAffiliated withDepartment of Medicine, University of Hong Kong, Queen Mary Hospital
  • , Siu Yin WongAffiliated withDepartment of Medicine & Surgery, Ruttonjee Hospital
  • , Carolyn KngAffiliated withDepartment of Medicine & Surgery, Ruttonjee Hospital
  • , Ka Man NgAffiliated withDepartment of Medicine, Princess Margaret Hospital
  • , Sik To LaiAffiliated withDepartment of Medicine, Princess Margaret Hospital
    • , Benjamin Chun Yu WongAffiliated withDepartment of Medicine, University of Hong Kong, Queen Mary Hospital

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Abstract

Background

This multicenter retrospective study investigated the management and outcome of patients with peptic ulcer/erosion-related aspirin and clopidogrel (A + C) cotherapy.

Methods

From January 2002 to September 2006, patients with endoscopically proven peptic ulcers/erosions after receiving A + C cotherapy were analyzed.

Results

This group consisted of 106 patients (age, 69.3 ± 11.7 years). Ulcers/erosions developed in 27 patients during hospitalization for cardiac events and in 79 patients after hospital discharge. Of 27 patients hospitalized for acute cardiac events, gastrointestinal (GI) bleeding and dyspepsia occurred in 24 and three, respectively. The most common lesion was gastric ulcer. Of 79 discharged patients, GI bleeding and dyspepsia occurred in 64 and 15, respectively. The most common bleeding and dyspeptic lesions were gastric ulcer and gastritis, respectively. Overall, 17 patients underwent endoscopic hemostasis all successfully. A + C cotherapy was continued in 57 patients for a median (interquartile range) of 3.0 (6.2) months. Most were coprescribed a proton pump inhibitor (PPI) (53, 93%). No recurrent GI bleeding was observed.

Conclusions

After A + C cotherapy, gastric ulcer or gastritis were the most common endoscopic lesions. The combination of a PPI and endoscopic treatment for ulcer bleeding was highly successful. After patient stabilization, continuation of A + C cotherapy with a PPI appears to be safe.

Key words

aspirin clopidogrel gastrointestinal bleeding peptic ulcer ischemic heart disease