No differences in gastrointestinal bleeding risk among clopidogrel-, ticagrelor-, or prasugrel-based dual antiplatelet therapy

Laredo, Viviana ; Sostres, Carlos (Universidad de Zaragoza) ; Garcia, Sandra ; Carrera-Lasfuentes, Patricia ; Revilla-Marti, Pablo ; Lanas, Ángel (Universidad de Zaragoza)

Resumen: The risk for gastrointestinal bleeding from dual antiplatelet therapy (DAPT) with new antiplatelets (prasugrel/ticagrelor) compared to clopidogrel is unclear. Aim: To determine the risk and type of major (gastrointestinal bleeding requiring hospitalization) and minor (anemia and iron deficiency) gastrointestinal events with different types of DAPT. Methods: Retrospective observational cohort study of patients who started DAPT after percutaneous coronary intervention. Follow-up was censored after 12 months of DAPT, when a major gastrointestinal event occurred, or when DAPT was discontinued. Results: Among 1, 327 patients (54.03% were treated with clopidogrel-based DAPT, 38.13% with ticagrelor-based DAPT, and 7.84% with prasugrel-based DAPT), 29.5% had at least one gastrointestinal event. Patients taking clopidogrel-DAPT were older, with more comorbidities, and higher gastrointestinal risk compared to those taking other DAPT regimens. Adjusted hazard ratios (HRs) showed no between-group differences in the risk for major (clopidogrel vs. new antiplatelets: HR 0.996; 95% confidence interval 0.497-1.996) and minor (HR 0.920; 0.712-1.189) gastrointestinal events. Most patients received proton pump inhibitors while on DAPT (93.3%) and after withdrawal (83.2%). Conclusion: Prasugrel- or ticagrelor-based DAPT was not associated with increased gastrointestinal bleeding risk when compared to clopidogrel-DAPT. New antiplatelets do not necessarily need to be restricted to patients with low gastrointestinal risk.

Idioma: Inglés

DOI: 10.3390/jcm9051526

Año: 2020

Publicado en: JOURNAL OF CLINICAL MEDICINE 9, 5 (2020), 1526 [10 pp.]
ISSN: 2077-0383

Factor impacto JCR: 4.241 (2020)

Categ. JCR: MEDICINE, GENERAL & INTERNAL rank: 39 / 169 = 0.231 (2020) - Q1 - T1

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)