title: Upper gastrointestinal complications induced by anti-platelet agents.
abstract: Low-dose aspirin and thienopyridine are associated with gastrointestinal (GI) complications such as petechiae, erosion, ulcer, bleeding, and perforation. The incidence of GI bleeding in aspirin study groups was 0.82 % in the hypertension optimal treatment (HOT) study and 0.76 % in the primary prevention project (PPP) study. On the other hand, the incidence of GI bleeding by endoscopic evaluation was higher than in an observational study. In a study of 187 patients receiving low-dose aspirin for prevention of cardiovascular disease, the prevalence of endoscopically detected GI ulcers was 11 % (95 % CI 6.3-15.1 %). Several risk factors for GI bleeding (history of peptic ulcer or GI bleeding, high aspirin dose, concomitant use of non-steroidal anti-inflammatory drugs and anti-platelet agents, advanced age and Helicobacter pylori infection) were reported for patients receiving aspirin. Prevention strategies for GI complications induced by anti-platelet agents are treatment with proton pump inhibitors, histamine-2 receptor antagonists, prostaglandin analogs, prostaglandin inducers and H. pylori eradication therapy. Further investigation is necessary to identify the strategies which are suitable for Japan.
authors.affiliation: Endoscopy Center, Tokyo Medical University Hospital, Tokyo, Japan. t-kawai@tokyo-med.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawai
authors.affiliation: Endoscopy Center, Tokyo Medical University Hospital, Tokyo, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Sugimoto
authors.affiliation: Endoscopy Center, Tokyo Medical University Hospital, Tokyo, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Fukuzawa
authors.affiliation: 4th Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Fukuzawa
authors.affiliation: 4th Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: Chika
authors.initials: C
authors.lastname: Kusano
authors.affiliation: 4th Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Gotoda
authors.affiliation: 4th Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
keywords: Adaptation; Gastrointestinal damage; H. pylori infection; Low-dose aspirin; Proton pump inhibitor