Journal of Gastroenterology

, Volume 43, Issue 9, pp 679–686

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

  • Fook Hong Ng
  • Pierre Chan
  • Chi Pong Kwanching
  • Ching Kong Loo
  • Ting Kin Cheung
  • Siu Yin Wong
  • Carolyn Kng
  • Ka Man Ng
  • Sik To Lai
  • Benjamin Chun Yu Wong
Alimmentary Tract

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 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Yusuf S, Zha, F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK. Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001;345:494–502.PubMedCrossRefGoogle Scholar
  2. 2.
    Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, et al. CLARITY-TIMI 28 Investigators. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction associated with ST-segment elevation. N Engl J Med 2005;352:1179–1189.PubMedCrossRefGoogle Scholar
  3. 3.
    Chen ZM, Jiang LX, Chen YP, Xie JX, Pan HC, Peto R, et al. COMMIT (Clopidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2006;366:1607–1621.Google Scholar
  4. 4.
    Tan K, Sulke N, Taub N, Sowton E. Clinical and lesion morphologic determinants of coronary angioplasty success and complications: current experience. J Am Coll Cardiol 1995;25:855–865.PubMedCrossRefGoogle Scholar
  5. 5.
    Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK, et al. Clopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) Investigators. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 2001;358:527–533.PubMedCrossRefGoogle Scholar
  6. 6.
    Steinhubl SR, Berger PB, Mann JT 3rd, Fry ET, DeLago A, Wilmer C, et al. CREDO Investigators. Clopidogrel for the Reduction of Events During Observation. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 2002;288:2411–2420.PubMedCrossRefGoogle Scholar
  7. 7.
    Shuchman M. Trading restenosis for thrombosis? New questions about drug-eluting stents. N Engl J Med 2006;355:1949–1952.PubMedCrossRefGoogle Scholar
  8. 8.
    Hallas J, Dall M, Andries A, Andersen BS, Aalykke C, Hansen JM, et al. Use of single and combined antithrombotic therapy and risk of serious upper gastrointestinal bleeding: population based case-control study. BMJ 2006;333:726–731.PubMedCrossRefGoogle Scholar
  9. 9.
    Rao AK, Pratt C, Berke A, Jaffe A, Ockene I, Schreiber TL, et al. Thrombolysis in Myocardial Infarction (TIMI) Trial—phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase. J Am Coll Cardiol 1988;11:1–11.PubMedCrossRefGoogle Scholar
  10. 10.
    Chin MW, Yong G, Bulsara MK, Rankin J, Forbes GM. Predictive and protective factors associated with upper gastrointestinal bleeding after percutaneous coronary intervention: a case-control study. Am J Gastroenterol 2007;102:2411–2416.PubMedCrossRefGoogle Scholar
  11. 11.
    Lee JG, Krucoff MW, Brazer SR. Periprocedural myocardial ischemia in patients with severe symptomatic coronary artery disease undergoing endoscopy: prevalence and risk factors. Am J Med 1995;99:270–275.PubMedCrossRefGoogle Scholar
  12. 12.
    Cappell MS, Iacovone FM Jr. Safety and efficacy of esophagogastroduodenoscopy after myocardial infarction. Am J Med 1999;106:29–35.PubMedCrossRefGoogle Scholar
  13. 13.
    Ng FH, Wong SY, Lam KF, Chang CM, Lau YK, Chu WM, et al. Gastrointestinal bleeding in patients receiving a combination of aspirin, clopidogrel and enoxaparin in acute coronary syndrome. Am J Gastroenterol 2008;103:865–871.PubMedCrossRefGoogle Scholar
  14. 14.
    Ng FH, Lam KF, Wong SY, Chang CM, Lau YK, Yuen WC, et al. Upper gastrointestinal bleeding in patients with aspirin and clopidogrel co-therapy. Digestion 2008;77:173–177.PubMedCrossRefGoogle Scholar
  15. 15.
    Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med 1999;340:1888–1899.PubMedCrossRefGoogle Scholar
  16. 16.
    Cappell MS. The safety and clinical utility of esophagogastroduodenoscopy for acute gastrointestinal bleeding after myocardial infarction: a six-year study of 42 endoscopies in 34 consecutive patients at two university teaching hospitals. Am J Gastroenterol 1993;88:344–350.PubMedGoogle Scholar
  17. 17.
    Chen L, Bracey AW, Radovancevic R, Cooper JR Jr, Collard CD, Vaughn WK, et al. Clopidogrel and bleeding in patients undergoing elective coronary artery bypass grafting. J Thorac Cardiovasc Surg 2004;128:425–431.PubMedCrossRefGoogle Scholar
  18. 18.
    van der Linden J, Lindvall G, Sartipy U. Aprotinin decreases postoperative bleeding and number of transfusions in patients on clopidogrel undergoing coronary artery bypass graft surgery: a double-blind, placebo-controlled, randomized clinical trial. Circulation 2005;112:276–280.CrossRefGoogle Scholar
  19. 19.
    Mangano DT, Tudor IC, Dietzel C, Multicenter Study of Perioperative Ischemia Research Group, Ischemia Research and Education Foundation. The risk associated with aprotinin in cardiac surgery. N Engl J Med 2006;354:353–365.PubMedCrossRefGoogle Scholar
  20. 20.
    Spertus JA, Kettelkamp R, Vance C, Decker C, Jones PG, Rumsfeld JS, et al. Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drugeluting stent placement: results from the PREMIER registry. Circulation 2006;113:2803–2809.PubMedCrossRefGoogle Scholar
  21. 21.
    Bavry AA, Kumbhani DJ, Helton TJ, Borek PP, Mood GR, Bhatt DL. Late thrombosis of drug-eluting stents: a meta-analysis of randomized clinical trials. Am J Med 2006;119:1056–1061.PubMedCrossRefGoogle Scholar
  22. 22.
    Eikelboom JW, Mehta SR, Anand SS, Xie C, Fox KA, Yusuf S. Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation 2006;114:774–782.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2008

Authors and Affiliations

  • Fook Hong Ng
    • 1
  • Pierre Chan
    • 2
  • Chi Pong Kwanching
    • 3
  • Ching Kong Loo
    • 4
  • Ting Kin Cheung
    • 2
  • Siu Yin Wong
    • 1
  • Carolyn Kng
    • 1
  • Ka Man Ng
    • 3
  • Sik To Lai
    • 3
  • Benjamin Chun Yu Wong
    • 2
  1. 1.Department of Medicine & SurgeryRuttonjee HospitalHong KongChina
  2. 2.Department of MedicineUniversity of Hong Kong, Queen Mary HospitalHong KongChina
  3. 3.Department of MedicinePrincess Margaret HospitalHong KongChina
  4. 4.Department of MedicineKwong Wah HospitalHong KongChina

Personalised recommendations