title: Upper gastrointestinal bleeding in patients with aspirin and clopidogrel co-therapy.
abstract: BACKGROUND
  The major complication of aspirin and clopidogrel (A+C) co-therapy is upper gastrointestinal bleeding (UGIB). However, data are unavailable for real-life situations. Furthermore, the treatment effect of antisecretory agents is unknown.
  
  
  OBJECTIVE
  This cohort study aimed to determine the occurrence of UGIB. The treatment effect of H2-receptor antagonist (H2RA) and proton pump inhibitor (PPI) was also analyzed.
  
  
  METHODS
  The records of 987 consecutive patients on A+C co-therapy between January 2001 and September 2006 were analyzed. The follow-up ended on the dates of a first occurrence of UGIB, stopping A+C co-therapy, a change in the antisecretory class, death, or March 2007.
  
  
  RESULTS
  After a follow-up of 5.8 +/- 6.5 months, UGIB occurred in 39 (4.0%) patients. PPI, H2RA and control were prescribed in 213, 287 and 487 patients respectively. After adjustment for age, dose of aspirin, previous UGIB and duration of treatment, the risk was marginally reduced by H2RA (OR = 0.43, 95% CI 0.18-0.91, p = 0.04) and significantly reduced by PPI (OR = 0.04, 95% CI 0.002-0.21, p = 0.002), as compared to control.
  
  
  CONCLUSIONS
  The occurrence of UGIB associated with A+C co-therapy for a median of 5.8 months was 4.0%. Co-prescription with PPI was associated with a lower risk.
authors.affiliation: Department of Medicine and Surgery, Ruttonjee Hospital, Hong Kong, SAR, China. ngfhong@hkucc.hku.hk
authors.forename: Fook-Hong
authors.initials: FH
authors.lastname: Ng
authors.forename: Kwok-Fai
authors.initials: KF
authors.lastname: Lam
authors.forename: Siu-Yin
authors.initials: SY
authors.lastname: Wong
authors.forename: Chee-My
authors.initials: CM
authors.lastname: Chang
authors.forename: Yuk-Kong
authors.initials: YK
authors.lastname: Lau
authors.forename: Wai-Cheung
authors.initials: WC
authors.lastname: Yuen
authors.forename: Wai-Ming
authors.initials: WM
authors.lastname: Chu
authors.forename: Benjamin C Y
authors.initials: BC
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use*; D000077144:Clopidogrel; D003327:Coronary Disease / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy*; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin