Evaluation of clopidogrel use on gastric precancerous lesions: Does it have chemopreventive effect?

Year 2023, , 524 - 529, 27.10.2023

Taner Akyol

https://doi.org/10.47582/jompac.1352478

Abstract

Aims: Gastric malignancies are the third most common cause of cancer-related deaths. Although aspirin and clopidogrel have been reported to reduce the risk of colorectal cancer, their effects on gastric cancer are still under investigation. In this study, we aimed to determine whether clopidogrel has an effect on the development of gastric precancerous lesions.
Methods: The study was designed as a retrospective case-control study. The study was conducted between January 2021 and April 2023 in the Gastroenterology Clinic of Samsun University Samsun Training and Research Hospital. Patients who underwent upper GIS endoscopy and biopsy examination due to dyspeptic complaints were scanned from the electronic data system of the hospital and their data were recorded by forming 4 groups as clopidogrel (89 patients), low-dose aspirin (ASA) (172 patients), non-aspirin non-steroidal anti-inflammatory drug (NA-NSAID) users (110 patients) and control group without antiplatelet use (110 patients). Statistical analyses were accomplished with SPSS for Windows v20.0.
Results: Mean duration of drug use was 2 years for clopidogrel, 1.47 years for ASA and 0.35 years for NA-NSAID. The incidence of peptic ulcer was 7.2% in the control group, 38%, 15.1%, 49% in clopidogrel, ASA, NA-NSAID users, respectively (p<0.001). The frequency of H. pylori infection in the groups was 61%, 53.5%, 40.1%, 46.1%, respectively. There was a significant difference between ASA and control group (p<0.001). Intestinal metaplasia was observed in 23.1%, 29.5%, 31.2%, 23.1%, respectively (p=0.291). Atrophic gastritis was 16.6%, 35.2%, 19.2%, 29.3%, respectively (p=0.003). No difference was observed between the groups in terms of dysplasia, gastric cancer and esophageal cancer.
Conclusion: According to our results, no preventive effects of clopidogrel, ASA and NA-NSAID use on precancerous lesions or gastric cancer development were observed. However, the use of these drugs was associated with severe gastroduodenal lesions.

Keywords

Aspirin, Clopidogrel, gastric cancer, gastric cancerous lesions

Ethical Statement

The local ethics committee of Samsun University Samsun Training and Research Hospital approved the study on 30.10.2019 with the decision number 2019/1/9.

Supporting Institution

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Project Number

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Thanks

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Mide prekanseröz lezyonlarında klopidogrel kullanımının değerlendirilmesi: Kemopreventif etkisi var mı?

Abstract

Amaç: Mide maligniteleri kansere bağlı ölümlerin en sık üçüncü nedenidir. Aspirin ve klopidogrelin kolorektal kanser riskini azalttığı bildirilse de mide kanseri üzerindeki etkileri halen araştırılmaktadır. Bu çalışmanın amacı; klopidogrelin gastrik prekanseröz lezyonların gelişiminde etkisinin olup olmadığını belirlemektir.
Gereç ve Yöntemler: Çalışma retrospektif vaka kontrol çalışması olarak tasarlandı. Çalışma Ocak 2021-Nisan 2023 tarihleri arasında Samsun Üniversitesi Samsun Eğitim ve Araştırma Hastanesi Gastroenteroloji Kliniğinde gerçekleştirildi. Dispepsi şikayeti nedeniyle üst GİS endoskopisi ve biyopsi incelemesi yapılan hastalar hastanenin elektronik veri sisteminden taranarak klopidogrel (89 hasta), düşük doz aspirin (ASA) (172 hasta), aspirin dışı non-steroid antiinflamatuar ilaç (NA-NSAID) (110 hasta) kullanıcıları ve antiplatelet kullanmayan kontrol grubu (110 hasta) olmak üzere 4 grup oluşturularak verileri kaydedildi. İstatistiksel analizler SPSS v20.0 ile yapıldı.
Bulgular: Ortalama ilaç kullanım süresi klopidogrel için 2 yıl, ASA için 1,47 yıl ve NA-NSAID için 0,35 yıl idi. Peptik ülser görülme sıklığı kontrol grubunda %7,2, klopidogrel, ASA, NA-NSAİİ kullananlarda sırasıyla %38, %15,1, %49 idi (p<0,001). Gruplarda H. pylori enfeksiyonu sıklığı sırasıyla %61, %53,5, %40,1, %46,1 idi. ASA ile kontrol grubu arasında anlamlı fark vardı (p<0,001). Bağırsak metaplazisi sırasıyla %23,1, %29,5, %31,2, %23,1 oranında görüldü (p=0,291). Atrofik gastrit oranları sırasıyla %16,6, %35,2, %19,2, %29,3 idi (p=0,003). Displazi, mide kanseri ve yemek borusu kanseri açısından gruplar arasında fark gözlenmedi.
Sonuç: Sonuçlarımıza göre klopidogrel, ASA ve NA-NSAID kullanımının prekanseröz lezyonları veya mide kanseri gelişimini önleyici etkisi gözlenmedi. Ancak bu ilaçların kullanımı ciddi gastroduodenal lezyonlarla ilişkilendirilmiştir.

Keywords

Anahtar Kelimeler: Aspirin, Klopidogrel, mide kanseri, mide kanserli lezyonlar

Project Number

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