Two Drugs Better Than One For Aspirin-induced Ulcer Bleeding
(Reuters Health) For patients who require an antiplatelet drug to prevent vascular disease, but have a history of aspirin-induced ulcer bleeding, aspirin plus esomeprazole appears to be a better choice than clopidogrel monotherapy, new research suggests.
Contrary to the researchers' hypothesis, the rate of recurrent bleeding with clopidogrel was actually much higher than that seen with aspirin plus esomeprazole. Moreover, the findings run counter to guidelines by the American College of Cardiology-American Heart Association, which recommend clopidogrel in this setting.
Dr. Francis K. L. Chan, from the Chinese University of Hong Kong, and colleagues assessed the rate of recurrent ulcer bleeding in 320 patients randomized to clopidogrel plus placebo, or to aspirin plus esomeprazole for 12 months. In all cases, the patients' ulcers had healed before being enrolled in the study.
During follow-up, recurrent bleeding occurred in 13 patients in the clopidogrel group and in just 1 patient in the aspirin plus esomeprazole group, Dr. Chan's group reports in the January 20th issue of The New England Journal of Medicine. The cumulative rates of recurrent bleeding for the clopidogrel and aspirin groups were 8.6% and 0.7%, respectively (p = 0.001).
Currently, it is recommended that clinicians substitute clopidogrel for aspirin in patients with aspirin-induced ulcer bleeding, Dr. Byron Cryer, from the University of Texas Southwestern Medical School in Dallas, notes in a related editorial. The present study, however, "clearly indicates that this recommendation is harmful and that such patients should be given aspirin plus a proton-pump inhibitor."
N Engl J Med 2005;352:238-244,287-289.
The above message comes from "Reuters Health", who is solely responsible for its content.
The above is for general informational purposes only. Always consult your
physician regarding specific medical issues and call Hatzalah or your local
ambulance service in the event of an emergency.
Home - About Us - Courses - Donate - Members - Safety Tips - Medical Digest
What is an Emergency? - Contact Us - Member Login