The role of clopidogrel in patients at risk for gastrointestinal (GI) complications is uncertain.
However, it has been recommended for patients who have gastrointestinal intolerance to aspirin.
Dr Kam-Chuen Lai and colleagues from Hong Kong tested the hypothesis that clopidogrel is as effective as esomeprazole and aspirin in preventing recurrent ulcer complications.
The researchers conducted a prospective, double-blind, randomized, controlled study of 170 patients who developed ulcer bleeding after the use of low-dose aspirin between 2002 and 2005.
After healing of ulcers and eradication of Helicobacter pylori, if present, patients were assigned randomly to treatment groups.
|Recurrent ulcer complications was 0% with combination therapy vs 14% with clopidogrel|
|Clinical Gastroenterology & Hepatology|
The researchers randomized 86 patients in Group 1 to esomeprazole 20 mg/day and aspirin 100 mg/day.
A further 84 patients in Group 2 received clopidogrel 75 mg/day for 52 weeks.
The primary end point was recurrent ulcer complications.
During a median follow-up period of 52 weeks, the team found that no patient in the esomeprazole group vs 9 patients in the clopidogrel group, developed recurrent ulcer complications.
The cumulative incidences of recurrent ulcer complications were 0% in patients receiving esomeprazole and aspirin.
The researchers observed recurrent ulcer complications in 14% of patients receiving clopidogrel.
Dr Lai's team concludes, “The combination of esomeprazole and aspirin is superior to clopidogrel in preventing ulcer complications in patients who have a past history of aspirin-related peptic ulcer bleeding.”