PMID- 18413689
OWN - NLM
STAT- MEDLINE
DCOM- 20080617
LR  - 20181201
IS  - 1542-6270 (Electronic)
IS  - 1060-0280 (Linking)
VI  - 42
IP  - 6
DP  - 2008 Jun
TI  - Single antiplatelet therapy for patients with previous gastrointestinal bleeds.
PG  - 836-40
LID - 10.1345/aph.1K566 [doi]
AB  - OBJECTIVE: To determine whether aspirin plus a proton pump inhibitor (PPI) is 
      preferable, from a gastrointestinal bleed (GIB) risk perspective, to clopidogrel 
      in patients who have experienced a GIB while on aspirin and who require single 
      antiplatelet therapy for secondary prevention of cardiovascular disease. DATA 
      SOURCES: A literature search was conducted using EMBASE (1980-January 2008), 
      PubMed (1966-January 2008), Google, and a manual search of the reference lists 
      using the search terms gastrointestinal bleed, gastrointestinal hemorrhage, 
      peptic ulcer hemorrhage, ASA, aspirin, Plavix, clopidogrel, and PPI. The search, 
      limited to human and English studies, yielded 110 returns. STUDY SELECTION AND 
      DATA EXTRACTION: Randomized trials that compared aspirin with clopidogrel, 
      involved patients who had previously experienced a GIB, and provided detailed 
      information on the type and dose of drugs used were included. Studies were 
      required to provide information on the recurrence of GIB. DATA SYNTHESIS: Two 
      randomized trials were reviewed to assess the safety of secondary prevention of 
      cardiovascular disease with respect to previous GIB. These noninferiority trials 
      compared aspirin plus a PPI with clopidogrel over 12 months following confirmed 
      healing of an aspirin-induced ulcer. In both trials, the majority of the GIB 
      recurrences were in the clopidogrel group (8.6% vs 0.7%; difference 7.9%; 95% CI 
      3.4 to 12.4; p = 0.001 and 13.6% vs 0%; difference 13.6%; 95% CI 6.3 to 20.9; p = 
      0.0019) and the difference in recurrence rates exceeded the a priori selected 
      upper boundary. CONCLUSIONS: Findings reported in the limited literature 
      available support that clopidogrel is not equivalent to the combination of 
      aspirin plus a PPI in the patient population studied. Aspirin plus a PPI would be 
      considered clinically superior and should be used in medically managed patients 
      who require single antiplatelet therapy but have had a prior GIB while on 
      aspirin. Further research regarding dual antiplatelet therapy and a PPI is 
      required.
FAU - Gellatly, Rochelle M
AU  - Gellatly RM
AD  - Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, 
      British Columbia, Canada.
FAU - Ackman, Margaret L
AU  - Ackman ML
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20080415
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Aged
MH  - Aspirin/adverse effects/therapeutic use
MH  - Cardiovascular Diseases/prevention & control
MH  - Clopidogrel
MH  - Drug Therapy, Combination
MH  - Female
MH  - Gastrointestinal Hemorrhage/*chemically induced
MH  - Humans
MH  - Male
MH  - Platelet Aggregation Inhibitors/adverse effects/*therapeutic use
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Recurrence
MH  - Ticlopidine/adverse effects/analogs & derivatives/therapeutic use
EDAT- 2008/04/17 09:00
MHDA- 2008/06/18 09:00
CRDT- 2008/04/17 09:00
PHST- 2008/04/17 09:00 [pubmed]
PHST- 2008/06/18 09:00 [medline]
PHST- 2008/04/17 09:00 [entrez]
AID - aph.1K566 [pii]
AID - 10.1345/aph.1K566 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2008 Jun;42(6):836-40. doi: 10.1345/aph.1K566. Epub 2008 Apr 
      15.