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. 2022 Sep 29;12(10):2364.
doi: 10.3390/diagnostics12102364.

Comparison of the Degree of Gastric Mucosal Injury between Patients Who Are Receiving Dual Antiplatelet Therapy or Single Antiplatelet Therapy

Yuji Shimada  1 , Mariko Hojo  2 , Yuji Kita  1 , Yuji Ikeda  1 , Sho Sato  1 , Ayato Murata  1 , Shunsuke Sato  1 , Kohei Matsumoto  2 , Yoichi Akazawa  2 , Tsutomu Takeda  2 , Kumiko Ueda  2 , Hiroya Ueyama  2 , Tomoyoshi Shibuya  2 , Takuya Genda  1 , Akihito Nagahara  2
Affiliations

Comparison of the Degree of Gastric Mucosal Injury between Patients Who Are Receiving Dual Antiplatelet Therapy or Single Antiplatelet Therapy

Yuji Shimada et al. Diagnostics (Basel). .

Abstract

Background: Patients taking low-dose aspirin have a higher incidence of gastroduodenal ulcers and higher risk of upper gastrointestinal bleeding than patients who do not. Thienopyridine antiplatelet agents may similarly cause bleeding gastroduodenal erosions and ulcers. The incidence of gastrointestinal bleeding is reported to be higher when these antithrombotic drugs are used in combination. Until now, most studies have focused on bleeding, and no study has compared the degree of gastric mucosal injury between patients receiving dual antiplatelet therapy (DAPT) and those receiving single antiplatelet therapy (SAPT) in real-world clinical practice.

Aim: Our objective was to compare the degree of gastric mucosal injury in patients taking low-dose aspirin in combination with clopidogrel (one of the thienopyridine antiplatelet agents) with that of patients who were taking aspirin or clopidogrel as a single agent.

Methods: Patients who were taking aspirin and/or clopidogrel and who underwent scheduled esophagogastroduodenoscopy between April 2015 and March 2020 were enrolled in this study. Endoscopic images were reviewed retrospectively, and the degree of gastric mucosal injury was assessed with the modified Lanza score (m-Lanza score). The m-Lanza score was compared between DAPT patients taking aspirin and clopidogrel and SAPT patients taking either aspirin alone or clopidogrel alone.

Results: The m-Lanza scores of the DAPT group, the aspirin group, and the clopidogrel group were 1.67 ± 1.81 (mean ± standard deviation), 0.95 ± 1.61, and 0.72 ± 1.29, respectively. The m-Lanza score of the DAPT group tended to be higher than that of the aspirin group (p = 0.06) and was significantly higher than that of the clopidogrel group (p = 0.03).

Conclusion: The degree of gastric mucosal injury in DAPT patients was significantly higher than that in patients using clopidogrel alone and tended to be higher than that in patients using aspirin alone in real-world clinical practice.

Keywords: clopidogrel; dual antiplatelet therapy; gastric mucosal injury; low-dose aspirin; single antiplatelet therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The flow chart of eligible patients. PCAB, potassium-competitive acid blocker; PPI, proton pump inhibitor; H2RA, histamine H2-receptor antagonist.
Figure 2
Figure 2
Box plots of the modified Lanza score (m-Lanza score) of the DAPT group, aspirin group, and clopidogrel group. ■ indicates the mean m-Lanza score. The m-Lanza score tended to be different among the DAPT group, aspirin group, and clopidogrel group (p = 0.09 by the Kruskal–Wallis test). * Between the DAPT group and each of the aspirin or clopidogrel group (p = 0.06 and p = 0.03, respectively, by the Mann–Whitney U test).
Figure 3
Figure 3
The proportions of patients with each modified Lanza score (m-Lanza score) in the DAPT group, aspirin group, and clopidogrel group. DAPT, dual antiplatelet therapy consisting of low-dose aspirin and clopidogrel.
See this image and copyright information in PMC

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