Introduction
It is known that Dual Anti-Platelet Therapy (DAPT) is a risk of gastrointestinal bleeding. Recently, it has been reported that concomitant use of proton pump inhibitor (PPI) can reduce the gastrointestinal bleeding risk (1). However, it is still unclear how DAPT affects the gastric mucosa. Actually, few reports have examined the relationship between DAPT and gastric mucosal injury (2).
Aims & Methods
The aim of this study is to reveal the difference of gastric mucosal injury between clopidogrel user and prasugrel user in patient receiving DAPT. This is a case-controlled study conducted at our department. Data were extracted from the records of subjects who underwent upper gastrointestinal endoscopy at our department between April 2015 and March 2022. We focused on the subjects taking both low-dose aspirin and P2Y12 receptor antagonist (DAPT). We compared the severity of gastric mucosal injury, between cases using clopidogrel (group C) and prasugrel (group P) individually according to the P2Y12 receptor antagonist used. Severity of gastric mucosal injury was evaluated endoscopically according to the modified LANZA score (MLS) (3, 4). Statistical analyses were performed by using Mann–Whitney U test. We evaluated separately for cases with concomitant use of potassium-competitive acid blocker (P-CAB) or PPI (user) and cases without concomitant use of P-CAB, PPI nor histamine H2 receptor antagonist (H2RA) (nonuser).
Results
82 cases out of 6,863 were receiving DAPT. In group C (45 men, 8 women; mean age 72.1 years), average MLS was 0.94±1.66 (user: n=33, score0=22, score1=4, score2=1, score3=2, score4=1, score5=3) and 1.82±1.88 (nonuser: n=17, score0=8, score1=0, score2=1, score3=4, score4=3, score5=1). In group P (21 men, 8 women; mean age 74.3 years), average MLS was 0.23±1.07 (user: n=22, score0=21, score1=0, score2=0, score3=0, score4=0, score5=1) and 0 (nonuser: n=6, score0=6, score1=0, score2=0, score3=0, score4=0, score5=0). There was a statistically significantly difference between group C and group P for both user(p=0.016) and nonuser(p=0.031). These results suggested that regardless of the concomitant use of antacids, prasugrel users had significantly less gastric mucosal injury than clopidogrel users in DAPT.
Conclusion
We found that prasugrel is more user-friendly agent than clopidogrel in terms of gastric mucosal injury in DAPT.
References
(1) Luo X, et al. Efficacy and safety of concomitant use of proton pump inhibitors with aspirin-clopidogrel dual antiplatelet therapy in coronary heart disease: A systematic review and meta-analysis. Front Pharmacol. 13:1021584. 2023
(2) Shimada Y, et al. Comparison of degree of gastric mucosal injury between patients who are receiving dual antiplatelet therapy or single antiplatelet therapy. Diagnostics. 29: 2364. 2022
(3) Lanza FL, et al. Endoscopic comparison of cimetidine and sucralfate for prevention of naproxen-induced acute gastroduodenal injury. Effect of scoring method. Dig Dis Sci. 35: 1494–1499. 1990
(4) Naito Y, et al. Prevention of indomethacin-induced gastric mucosal injury in Helicobacter pylori-negative healthy volunteers: a comparison study rebamipide vs famotidine. J Clin Biochem Nutr. 43: 34–40. 2008