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

• Published in: Journal of gastroenterology 2008-09, Vol.43 (9), p.679-686
• Main Authors: Ng, Fook Hong, Chan, Pierre, Kwanching, Chi Pong, Loo, Ching Kong, Cheung, Ting Kin, Wong, Siu Yin, Kng, Carolyn, Ng, Ka Man, Lai, Sik To, Wong, Benjamin Chun Yu
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Aged; Alimmentary Tract; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Aspirin - administration & dosage; Aspirin - adverse effects; Colorectal Surgery; Coronary Disease - therapy; Female; Gastroenterology; Gastrointestinal Hemorrhage - therapy; Hemostasis, Endoscopic; Hepatology; Hospitalization; Humans; Male; Medicine; Medicine & Public Health; Peptic Ulcer - chemically induced; Peptic Ulcer - complications; Peptic Ulcer - therapy; Platelet Aggregation Inhibitors - therapeutic use; Stents; Surgical Oncology; Ticlopidine - administration & dosage; Ticlopidine - adverse effects; Ticlopidine - analogs & derivatives
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-008-2215-4

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.