Clinical analysis of antiplatelet therapy-induced gastrointestinal injury in the elderly
10.3760/cma.j.issn.0254-9026.2011.05.002
- VernacularTitle:抗血小板治疗对老年人胃肠道损伤的临床分析
- Author:
Haijuan ZHOU
;
Yu ZHANG
- Publication Type:Journal Article
- Keywords:
Aspirin;
Platelet aggregation inhibitors;
Gastrointestinal injury
- From:
Chinese Journal of Geriatrics
2011;30(5):358-361
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the risk effects of different antiplatelet therapies on gastrointestinal injury and summarize the endoscopic characteristics of gastrointestinal mucosal injury in the elderly. Methods The dyspepsia symptoms, gastrointestinal bleeding and endoscopic findings were retrospectively evaluated among 577 patients who received the antiplatelet therapy with aspirin and/or clopidogrel. Results The risk of dyspepsia symptoms and gastrointestinal bleeding was slightly higher in clopidogrel group than in aspirin group (both P＞0.05, x2=0.48, 0.72), and OR (95% CI): 1.10 (0.59-2.07) and 1.74 (0.48-6.33), for the risk of dyspepsia symptoms and gastrointestinal bleeding, respectively. In aspirin plus clopidogrel group, the risk of dyspepsia symptoms had no significant increase as compared with aspirin or clopidogrel group (x2=0.37, 0.03, for aspirin or clopidogrel group, respectively, both P＞0.05), but the risk of gastrointestinal bleeding was significantly higher than in aspirin group (x2=5.43, P＜0.05), OR (95% CI): 4.77 (1.15-19.79) and slightly higher than in clopidogrel group (P＞0.05). In this study, 57 patients received endoscopy and the detection rate of erosion or ulcer was 78.9%. Erosion (61.4%) was most in the gastric antrum; gastric ulcer (10.6%) located in gastric antrum and angle; duodenal ulcer (18.0%) located in bulb. In patients with dyspepsia symptoms erosion (70.5%), were most likely found but patients with gastrointestinal bleeding showed mainly ulcer (69.2%). Conclusions In the elderly the use of clopidogrel alone is not safer than low-dose aspirin and the combination would increase the risk of gastrointestinal bleeding. The detection rate of erosion or ulcer is high in patients with symptoms. Patients with dyspepsia symptoms most likely show erosion, but patients with gastrointestinal bleeding have mainly ulcer and complex ulcers more common.
