Upper gastrointestinal bleeding associated with antiplatelet drugs

Abstract

SUMMARY BackgroundThe risk of major upper gastrointestinal bleeding associated with various antiplatelet drugs and the protection conferred by gastroprotective agents are not well defined.

Gastrointestinal Events with Clopidogrel: A Nationwide Population-Based Cohort Study

“…While other studies have evaluated clopidogrel use specifically in patients diagnosed with GI bleeding, [15][16][17] this is the first large study to investigate clopidogrel use in a broader spectrum of patients and determine its association with GI events. In a nationwide population, the risk of adverse GI events was significantly increased in all patients treated with clopidogrel, regardless of dose and with numbers needed to harm ranging from 58 to 33 patients receiving 12 months of clopidogrel treatment.…”

“…Previous studies have consistently reported that no dose-response relationship exists for aspirin-related risk of GI ulcer or bleeding. 8,15,30 In clinical practice, all patients treated with clopidogrel receive 75 mg daily, and the figure thus also reflects the importance of treatment duration. Moreover, the groups continue to separate, thus supporting the importance of ischaemic heart disease as a risk factor for adverse GI events.…”

“…However, more recent studies have reported a significantly increased risk of GI bleeding during treatment with clopidogrel. 14,15 Importantly, the risk of bleeding increases when combining clopidogrel with aspirin. 16,17 Currently, the use of proton pump inhibitors is the prevailing strategy for the prevention of GI bleeding during antiplatelet therapy.…”

Gastroduodenal Mucosal Injury Profile in Long-Term Low-Dose Aspirin Users and Its Influencing Factors

“…Ibanez et al described that PPI administration in low-dose aspirin users would decrease the risk of gastrointestinal bleeding from 4.0 (3.2-4.9) to 1.1 (0.5-2.6). 13 Study by Lanas A et al also revealed that PPI decreased the risk of upper gastrointestinal bleeding with OR = 0.09 (95% CI: 0.01-0.69). 46 Gracia et al reported that PPI administration for less than 1 month did not significantly decrease the risk of upper gastrointestinal bleeding (OR = 2.9; 95% CI: 2.1-4.2); however, this became significant if administered for more than 1 month with OR = 0.6 (95% CI: 0.4-1,0).…”

“…7,8 However, more studies associated the use of aspirin with gastrointestinal bleeding. [9][10][11][12][13][14] In a large study involving 27,694 patients, upper gastrointestinal bleeding was found in 2.6% of aspirin users. 15 But, clinical symptom does not always present in mucosal injury due to aspirin administration.…”