Endoscopic evidence of mucosal injury in patients taking ticlopidine compared with patients taking aspirin/nonsteroidal antiinflammatory drugs and controls.
BACKGROUND
Ticlopidine is a novel antiplatelet agent used alone or in combination with aspirin and anticoagulants in the treatment and prevention of various vascular diseases. Gastrointestinal side effects, including bleeding, have been reported with use of ticlopidine in most of the vascular prevention trials. We studied the endoscopic evidence of mucosal damage in patients taking ticlopidine compared with patients taking aspirin/nonsteroidal antiinflammatory drugs (NSAIDs) and matched controls.


METHODS
We performed a longitudinal review of gastrointestinal endoscopy, pharmacy databases, and medical records of patients referred to our service over a period of 6 months for endoscopic evaluation of upper gastrointestinal bleeding, unexplained anemia, or abdominal pain. Data were collected and analyzed for 55 patients taking ticlopidine, 77 age- and gender-matched patients taking aspirin or NSAIDs, and 560 age- and gender-matched control patients not taking any of these medications.


RESULTS
The overall prevalence of ulcers was marginally higher in the aspirin/NSAID group than in the ticlopidine group (35% vs. 29%) and was significantly higher among patients taking aspirin, NSAIDs, or ticlopidine than among controls (15%). Gastritis was also noted more frequently in the aspirin/NSAID and ticlopidine groups than in the control group. Endoscopic evidence of esophagitis was significantly more frequent in the control group than in the aspirin/NSAID and ticlopidine groups. There was no significant difference across groups in the prevalence of ulcers, gastritis, or esophagitis.


CONCLUSIONS
Patients taking ticlopidine are more likely to have endoscopic evidence of mucosal damage than matched control patients and are nearly as likely to have such damage as endoscopically evaluated patients taking aspirin or NSAIDs. However, these findings must be confirmed using prospective cohort data for patients in primary care settings, to avoid referral bias.
Sheikh
Rafiq A
RA
Division of Gastroenterology, Department of Medicine, University of California Davis Medical Center, Sacramento, CA, USA. rasyas@yahoo.com
Romano
Patrick S
PS
Prindiville
Thomas P
TP
Yasmeen
Shagufta
S
Trudeau
Walter
W
D000740:Anemia / Q000139:chemically induced; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D016022:Case-Control Studies; D016208:Databases, Factual; D004941:Esophagitis / Q000139:chemically induced; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects; D005756:Gastritis / Q000139:chemically induced; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000139:chemically induced; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015995:Prevalence; D013988:Ticlopidine / Q000009:adverse effects* / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D010975:Platelet Aggregation Inhibitors; D013988:Ticlopidine; D001241:Aspirin