[Antiplatelet therapy after aspirin-induced upper gastrointestinal bleeding].
It is common practice to replace aspirin with clopidogrel in patients with gastrointestinal intolerance to aspirin. Recent studies suggest that a combination of aspirin and a proton pump inhibitor is a better alternative for these patients. The CAPRIE and CURE studies have not shown any clinically relevant difference in effect between aspirin and clopidogrel. The incidence of bleeding is also similar when aspirin is used in doses < 160 mg. A recent study by Chan et al. concluded that a combination of aspirin and esomeprazole is superior to clopidogrel in the prevention of recurrent gastrointestinal bleeding. Using aspirin and a proton pump inhibitor is also the least expensive alternative.
Johansen
Maren
M
RELIS Øst, Klinisk kjemisk avdeling, Laboratoriemedisinsk divisjon, Ullevål universitetssykehus, 0407 Oslo. maren.johansen@relis.ulleval.no
D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination; D064098:Esomeprazole / Q000008:administration & dosage / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000897:Anti-Ulcer Agents; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D064098:Esomeprazole; D013988:Ticlopidine; D001241:Aspirin