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 25 February 2018

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News

Clopidogrel vs aspirin + esomeprazole for recurrent ulcer bleeds

Findings in this week's New England Journal of Medicine do not support the current recommendation that patients with major gastrointestinal intolerance of aspirin be given clopidogrel, aspirin plus esomeprazole is superior.

News image

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Concurrent therapy with a proton-pump inhibitor is a standard treatment for patients receiving aspirin who are at risk for ulcer.

Current U.S. guidelines also recommend clopidrogel for patients who have major gastrointestinal intolerance of aspirin.

Dr Chan and colleagues from Hong Kong undertook a study in order to compare clopidogrel with aspirin plus esomeprazole for the prevention of recurrent bleeding from ulcers in high-risk patients.

The researchers studied patients who took aspirin to prevent vascular diseases and who presented with ulcer bleeding.

After the ulcers had healed, the research team randomly assigned patients who were negative for Helicobacter pylori into 1 of 2 groups.

The first group received 75 mg of clopidogrel daily plus esomeprazole placebo twice daily and the second group was given 80 mg of aspirin daily plus 20 mg of esomeprazole twice daily for 12 months.

The end point was recurrent ulcer bleeding.

Recurrent ulcer bleeding occurred in 13 patients receiving clopidogrel and 1 receiving aspirin plus esomeprazole
New England Journal of Medicine

The researchers enrolled a total of 320 patients, of which 161 patients were assigned to receive clopidogrel and 159 to receive aspirin plus esomeprazole).

The research team found that recurrent ulcer bleeding occurred in 13 patients receiving clopidogrel and 1 receiving aspirin plus esomeprazole.

The researchers also found that the cumulative incidence of recurrent bleeding during the 12-month period was 9% among patients who received clopidogrel and 1% among those who received aspirin plus esomeprazole.

Dr Chan concluded, "Among patients with a history of aspirin-induced ulcer bleeding whose ulcers had healed before they received the study treatment, aspirin plus esomeprazole was superior to clopidogrel in the prevention of recurrent ulcer bleeding."

"Our finding does not support the current recommendation that patients with major gastrointestinal intolerance of aspirin be given clopidogrel."

New England Journal of Medicine; 2005: 352 (3): 238-44
24 January 2005

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