Τίτλος:
Upper gastrointestinal haemorrhage complicating antiplatelet treatment
with aspirin and/or clopidogrel: Where we are now?
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
A large number of patients require antiplatelet therapy (mainly aspirin
and/or clopidogrel). Recent studies suggest that the combination of
these agents is useful in patients with acute coronary syndrome and
after percutaneous coronary intervention with stent placement. On the
other hand, bleeding complications, most of which arise from the upper
gastrointestinal (UGI) tract, can limit the use of antiplatelet drugs.
Clopidogrel appears to be associated with fewer UGI side effects and
bleeding compared with aspirin. However, a history of previous UGI
bleeding is a major risk factor for clopidogrel-associated bleeding. The
use of proton-pump inhibitors (PPIs) decreases the rate of UGI bleeding
in patients receiving aspirin or clopidogrel. Furthermore, a recent
study suggested that the administration of low-dose aspirin plus
high-dose esomeprazole (a potent PPI) was associated with fewer episodes
of UGI bleeding than clopidogrel alone in patients with a history of
recent UGI haemorrhage. However, this study had several limitations and
its results should be cautiously extrapolated into clinical practice.
The combination of aspirin plus clopidogrel increases the risk of UGI
bleeding. Unfortunately, there are no data on the effect of PPI
prophylaxis in this setting. Available evidence suggests that where
aspirin and/or clopidogrel are to be started or continued in patients
with a recent history of UGI ulceration or bleeding (after ulcer healing
and eradication of H. pylori infection), treatment with a PPI is a
useful precaution. The patients should also be carefully monitored for
recurrence of UGI bleeding.
Συγγραφείς:
Liberopoulos, EN
Elisaf, MS
Tselepis, AD
Archimandritis, A
and Kiskinis, D
Cokkinos, D
Mikhailidis, DP
Εκδότης:
Taylor and Francis Inc.
Λέξεις-κλειδιά:
aspirin; clopidogrel; coronary heart disease; gastrointestinal bleeding;
stroke; peptic ulcer; proton pump inhibitor
DOI:
10.1080/09537100500237004
