[Aspirin and cardiovascular prevention: last minute information].
Just a few days after the publication in this journal of a review on aspirin and cardiovascular prevention, a significant article appeared in the international literature; it provides new information and deserves a brief presentation. This paper is concerned with patients who took aspirin to prevent vascular diseases and who presented with ulcer bleeding. After the ulcers had healed and after eradication of Helicobacter pylori had, if necessary, been achieved, 320 patients were randomly assigned to receive either 75 mg of clopidogrel daily or 80 mg of aspirin daily + 20 mg of esomeprazole twice daily. Recurrent ulcer bleeding occurred in 13 of the 161 patients assigned to receive clopidogrel and in 1 of the 159 who received aspirin plus esomeprazole. The cumulative incidence of recurrent bleeding during the 12 months of follow up was 8.6% in the clopidogrel group and 0.7% in the aspirin-esomeprazole group (p = 0.001). These findings do not support a current American recommendation that patients with major gastrointestinal intolerance of aspirin should be given clopidogrel instead.
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D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000517:prevention & control; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D013988:Ticlopidine / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives*
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin