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The gastrointestinal adverse effects of low dose aspirin compared with clopidogrel

Year 2007, Volume: 6 Issue: 2, 68 - 71, 01.08.2007

Abstract

Background/aims: Aside from its gastrointestinal adverse effects, aspirin is the most efficacious antiplatelet agent in clinical use today because of its easy usage, long-term experience and low cost. A related drug, clopidogrel, has been proposed as a substitute. Our aim was to evaluate the gastrointestinal adverse effects of aspirin and clopidogrel usage by means of endoscopy, symptom scoring and following gastrointestinal bleeding. Materials and methods: Fifty patients with coronary artery disease, cerebrovascular disease, diabetes mellitus, congestive heart failure, hypertension or transient ischemic attack (34 F, 16 M, average age: 59±10) were included in the present study. The participants were randomized to receive either aspirin 100 mg/day or clopidogrel 75 mg/day. Results: According to the results of our study, there were no statistical differences in hemorrhagic risk, symptom scores or endoscopic findings in patients who had used low-dose aspirin or clopidogrel (P>0.5). Conclusions: Our results indicate that aspirin and clopidogrel are comparable drugs. Further investigations are needed to evaluate whether clopidogrel may be used instead of aspirin to avoid its gastrointestinal adverse effects.

References

  • Moshefegh K, Redondo M, et al. Antiplatelet effects of klopidogrel with aspirin after myocardial infarction: enhanced inhibitory effects of combination therapy. J Am Coll Cardiol 2000; 36: 699-705.
  • Scrutinio D, Cimminiello C, et al. Ticlopidine versus aspirin after myocardial infarction (STAMİ) trial. J Am Coll Cardiol 2001; 37: 1259-65.
  • Jaszewski R. Frequency of gastroduodenal lesions in asymptomatic patients on chronic aspirin or nonsteroidal antiinflammatory drug therapy. J Clin Gastroenterol 1990; 12: 10-3.
  • Bhatt DL, Chew DP, et al. Superiority of Klopidogrel Versus Aspirin in Patients With Prior Cardiac Surgery. Circulation 2001; 103: 363-8.
  • Ng FH, Wong BC, et al. Klopidogrel plus omeprazole compared with aspirin plus omeprazole for aspirin-induced symptomatic peptic ulcers/erosions with low to moderate bleeding/re-bleeding risk - a single-blind, randomized controlled study. Aliment Pharmacol Ther 2004; 19: 359-65.
  • Ng FH, Wong SY, et al. High incidence of klopidogrel-associated gastrointestinal bleeding in patients with previous peptic ulcer disease. Aliment Pharmacol Ther 2003; 18: 443-9.
  • Perri F, Ciement R, Festa V, et al. Patterns of symptoms in functional dyspepsia: Role of Helicobacter pylori infection and delayed gastric emptying. Am J Gastroenterol 1998; 93 : 2082-8.
  • Collaborative overview of randomised trials of antiplatelet therapy, I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Br Med J 1994; 308: 81-106.
  • UK_TIA Study Group. The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatry 1991; 54: 1044-54.
  • Limmer S, Ittel TH, et al. Secondary and primary prophylaxis of gastropathy associated with nonsteroidal antiinflammatory drugs or low-dose-aspirin: a review based on four clinical scenarios. Z Gastroenterol 2003; 41: 719-28.
  • Schafer AI. Antiplatelet therapy. Am J Med 1996; 101: 199-209.
  • Mizuno H, Sakamoto C, Matsuda K, et al. Introduction of cyclooxygenase 2 in gastric mucosal lesions and its inhibition by the spesific antagonist delays in mice. Gastroenterology 1997; 112: 287-97.
  • Sihigeta J, Takahashi S, Okabe S. Role of cyclooxygenase-2 in the healing of gastric ulcers in rats. J pharmacol Exp Ther 1998; 286: 1383-90.
  • CAPRIE Steering Committee. A randomized, blinded, trial of clopi dogrel versus aspirin in patients at risk of ischemic event (CAPRIE). Lancet 1996; 348: 1329-39.
  • Wong SK, Yu LM, Lau JY, et al. Prediction of therapeutic failure after adrenaline injection plus heater probe treatment in patients with bleeding peptic ulcer. Gut 2002; 50: 322-5.
  • ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streprokinase, oral aspirin, bot hor neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988; 2: 349-60.
  • Cairns JA, Gent M, Singer J, et al. Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. N Eng J Med 1985; 131: 1369-75.
  • Yusuf S, Zhao F, Mehta ST, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST segment elevation. The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. N Engl J Med 2001; 345: 494502.

Düşük doz aspirin ve klopidogrel kullanımına bağlı gastrointestinal yan etkilerin değerlendirilmesi

Year 2007, Volume: 6 Issue: 2, 68 - 71, 01.08.2007

Abstract

Giriş ve amaç: Aspirin gastrointestinal sistemdeki olumsuz yan etkilerine rağmen kullanım kolaylığı, uzun yıllara giden bilgi birikimi ve maliyeti nedeniyle klinik kullanımda en etkili olan antiplatelet ajandır. Aspirin yerine kullanılabilecek diğer bir ilaç klopidogreldir. Biz de bu çalışmada aspirin ve klopidogrel kullanımı ile gastrointestinal yan etkilerin endoskopi, semptom skorlaması ve gastrointestinal kanama takibiyle değerlendirilmesini amaçladık. Gereç ve yöntem: Çalışmaya koroner arter hastalığı, serebrovasküler hastalık, diyabet, konjestif kalp yetmezliği, hipertansiyonu veya geçici iskemik atağı olan 34'ü kadın, 16'sı erkek, yaş ortalaması 59±10 olan toplam 50 hasta alındı. Bu hastalara randomize olarak aspirin 100 mg/gün veya klopidogrel 75 mg/gün verildi. Bulgular: Çalışmamızın sonuçları na göre düşük doz aspirin ya da klopidogrel kullanan hastalarda istatistiksel olarak kanama riski, semptom skoru ve endoskopik bulgularda anlamlı bir farklılık saptanmadı (P>0.5). Sonuç: Her iki ilaç da gastrointestinal yan etkiler açısından güvenilir görünmektedir. Klopidogrelin aspirini tolere edemeyen hastalar için alternatif olabilmesi konusunda daha geniş çaplı çalışmalara ihtiyaç olduğu açıktır.

References

  • Moshefegh K, Redondo M, et al. Antiplatelet effects of klopidogrel with aspirin after myocardial infarction: enhanced inhibitory effects of combination therapy. J Am Coll Cardiol 2000; 36: 699-705.
  • Scrutinio D, Cimminiello C, et al. Ticlopidine versus aspirin after myocardial infarction (STAMİ) trial. J Am Coll Cardiol 2001; 37: 1259-65.
  • Jaszewski R. Frequency of gastroduodenal lesions in asymptomatic patients on chronic aspirin or nonsteroidal antiinflammatory drug therapy. J Clin Gastroenterol 1990; 12: 10-3.
  • Bhatt DL, Chew DP, et al. Superiority of Klopidogrel Versus Aspirin in Patients With Prior Cardiac Surgery. Circulation 2001; 103: 363-8.
  • Ng FH, Wong BC, et al. Klopidogrel plus omeprazole compared with aspirin plus omeprazole for aspirin-induced symptomatic peptic ulcers/erosions with low to moderate bleeding/re-bleeding risk - a single-blind, randomized controlled study. Aliment Pharmacol Ther 2004; 19: 359-65.
  • Ng FH, Wong SY, et al. High incidence of klopidogrel-associated gastrointestinal bleeding in patients with previous peptic ulcer disease. Aliment Pharmacol Ther 2003; 18: 443-9.
  • Perri F, Ciement R, Festa V, et al. Patterns of symptoms in functional dyspepsia: Role of Helicobacter pylori infection and delayed gastric emptying. Am J Gastroenterol 1998; 93 : 2082-8.
  • Collaborative overview of randomised trials of antiplatelet therapy, I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Br Med J 1994; 308: 81-106.
  • UK_TIA Study Group. The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatry 1991; 54: 1044-54.
  • Limmer S, Ittel TH, et al. Secondary and primary prophylaxis of gastropathy associated with nonsteroidal antiinflammatory drugs or low-dose-aspirin: a review based on four clinical scenarios. Z Gastroenterol 2003; 41: 719-28.
  • Schafer AI. Antiplatelet therapy. Am J Med 1996; 101: 199-209.
  • Mizuno H, Sakamoto C, Matsuda K, et al. Introduction of cyclooxygenase 2 in gastric mucosal lesions and its inhibition by the spesific antagonist delays in mice. Gastroenterology 1997; 112: 287-97.
  • Sihigeta J, Takahashi S, Okabe S. Role of cyclooxygenase-2 in the healing of gastric ulcers in rats. J pharmacol Exp Ther 1998; 286: 1383-90.
  • CAPRIE Steering Committee. A randomized, blinded, trial of clopi dogrel versus aspirin in patients at risk of ischemic event (CAPRIE). Lancet 1996; 348: 1329-39.
  • Wong SK, Yu LM, Lau JY, et al. Prediction of therapeutic failure after adrenaline injection plus heater probe treatment in patients with bleeding peptic ulcer. Gut 2002; 50: 322-5.
  • ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streprokinase, oral aspirin, bot hor neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988; 2: 349-60.
  • Cairns JA, Gent M, Singer J, et al. Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. N Eng J Med 1985; 131: 1369-75.
  • Yusuf S, Zhao F, Mehta ST, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST segment elevation. The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. N Engl J Med 2001; 345: 494502.
There are 18 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Ayşe Çarlıoğlu This is me

Mehtap Erkmen Uyar This is me

Aydın Karanfil This is me

Cansel Türkay This is me

Burak Uz This is me

Publication Date August 1, 2007
Published in Issue Year 2007 Volume: 6 Issue: 2

Cite

APA Çarlıoğlu, A., Uyar, M. E., Karanfil, A., Türkay, C., et al. (2007). Düşük doz aspirin ve klopidogrel kullanımına bağlı gastrointestinal yan etkilerin değerlendirilmesi. Akademik Gastroenteroloji Dergisi, 6(2), 68-71.

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