Korean J Gastroenterol.  2014 Aug;64(2):81-86. 10.4166/kjg.2014.64.2.81.

Clinical Impact of Dual Antiplatelet Therapy on Peptic Ulcer Disease

• Ahn DG
• Kim BJ
• Kim JW
• Kim JG

• KMID: 2164417
• DOI: http://doi.org/10.4166/kjg.2014.64.2.81

Abstract

BACKGROUND/AIMS
Increased incidence of coronary artery disease has led to the increased use of dual antiplatelet therapy composed of aspirin and clopidogrel. We investigated the incidence of gastrointestinal complications in patients who received single or dual antiplatelet therapy and analyzed their clinical characteristics in order to predict the prognostic factors.
METHODS
Between January 2009 and December 2011, we retrospectively reviewed the medical records of patients who underwent coronary angiography at Chung-Ang University Hospital (Seoul, Korea). One hundred and ninety-four patients were classified into two groups: aspirin alone group and dual antiplatelet group. Clinical characteristics, past medical history, and presence of peptic ulcer were analyzed.
RESULTS
During the follow-up period, 11 patients had duodenal ulcer; the event rate was 2.02% in the aspirin alone group and 9.47% in the dual antiplatelet group (hazard ratio [HR] 5.24, 95% CI 1.03-26.55, p<0.05). There was no significant difference in the rate of significant upper gastrointestinal bleeding: 0% vs. 4.2% (p=0.78). In patients who received proton pump inhibitor (PPI), 24 patients had gastric ulcer; the event rate was significantly different between the two groups: 4.87% vs. 22.98% (HR 3.40, 95% CI 1.02-11.27, p<0.05).
CONCLUSIONS
Dual antiplatelet groups had a higher incidence of duodenal ulcers without significant bleeding compared with the aspirin alone group. In patients who received PPI, the dual antiplatelet therapy group had a higher incidence of gastric ulcers without significant bleeding compared with the aspirin alone group. Therefore, physicians must pay attention to high risk groups who receive dual antiplatelet therapy and aggressive diagnostic endoscopy should also be considered.

Keyword

Platelet aggregation inhibitors; Endoscopes; Gastrointestinal hemorrhage; Peptic ulcer

MeSH Terms

Aged
Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use/toxicity
Aspirin/*therapeutic use/toxicity
Coronary Angiography
Coronary Artery Disease/*prevention & control
Drug Therapy, Combination
Female
Gastrointestinal Hemorrhage/chemically induced/prevention & control
Humans
Incidence
Male
Middle Aged
Peptic Ulcer/*diagnosis/epidemiology/etiology
Platelet Aggregation Inhibitors/*therapeutic use/toxicity
Proportional Hazards Models
Proton Pump Inhibitors/therapeutic use
Retrospective Studies
Risk Factors
Ticlopidine/*analogs & derivatives/therapeutic use/toxicity
Aspirin
Anti-Inflammatory Agents, Non-Steroidal
Platelet Aggregation Inhibitors
Proton Pump Inhibitors
Ticlopidine

Reference

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