title: [The effect of aspirin alone or aspirin plus additional antiplatelets therapy on upper gastrointestinal hemorrhage].
abstract: OBJECTIVE
  The increasing incidence of cardiovascular disease has led to an increase in the frequency of upper gastrointestinal (GI) hemorrhage due to the use of antiplatelet agents. This study examined the clinical characteristics of patients with upper GI hemorrhage who were administered aspirin alone or a combination treatment of antiplatelet agents.
  
  
  METHODS
  A 656 patients who underwent drug-eluting coronary stenting at Ewha Mokdong Hospital in 2008 were divided into three groups according to the antiplatetlet agents used after the intervention; groups of aspirin alone, aspirin plus clopidogrel, and aspirin, and clopidogrel plus another antiplatelet agent, respectively. Patients admitted with GI hemorrhage in the same period without a medication history of antiplatelet or nonsteroidal anti-inflammatory drugs were used as the control hemorrhage group. The medical records were reviewed.
  
  
  RESULTS
  Significant GI symptoms were observed in 21.1% of total patients, of whom 48.2% had ulcers. The upper GI hemorrhage rate was 3.8%. There was no significant difference in the hemorrhage rate between three groups. Compared to the control hemorrhage group, the endoscopic variables of the antiplatelet-related hemorrhage group were not significantly different. However, the Helicobacter pylori infection rate was lower, the admission period was longer, and the mortality rate was higher in the antiplatelet-related hemorrhage group (p<0.05, respectively). There was no direct association between restarting or discontinuance of antiplatelets after the hemorrhage event and mortality.
  
  
  CONCLUSIONS
  Adding other antiplatelet agents to aspirin did not increase the hemorrhage rate. However, active diagnostic and therapeutic efforts are recommended in patients with GI symptoms during antiplatelet therapy.
authors.affiliation: Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Suh Eun
authors.initials: SE
authors.lastname: Bae
authors.forename: Seong-Eun
authors.initials: SE
authors.lastname: Kim
authors.forename: Sung-Ae
authors.initials: SA
authors.lastname: Jung
authors.forename: So Yoon
authors.initials: SY
authors.lastname: Yoon
authors.forename: Ki-Nam
authors.initials: KN
authors.lastname: Shim
authors.forename: Hye-Kyung
authors.initials: HK
authors.lastname: Jung
authors.forename: Tae Hun
authors.initials: TH
authors.lastname: Kim
authors.forename: Kwon
authors.initials: K
authors.lastname: Yoo
authors.forename: Il Hwan
authors.initials: IH
authors.lastname: Moon
mesh_terms: D000368:Aged; D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000401:mortality / Q000517:prevention & control; D016481:Helicobacter Infections / Q000150:complications / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin