Magnetically Controlled Capsule Endoscopy for Assessment of Antiplatelet Therapy–Induced Gastrointestinal Injury

Han, Yaling; Liao, Zhuan; Li, Yang; Zhao, Xianxian; Ma, Shuren; Bao, Dan; Qiu, Miaohan; Deng, Jie; Wang, Jinhai; Qu, Peng; Jiang, Chunmeng; Jia, Shanshan; Yang, Shaoqi; Ru, Leisheng; Feng, June; Gao, Wei; Huang, Yonghui; Tao, Ling; Han, Ying; Yang, Kun; Wang, Xiaoyan; Zhang, Wenjuan; Wang, Bangmao; Li, Yue; Yang, Youlin; Li, Junxia; Sheng, Jiangqiu; Ma, Yan; Cui, Min; Ma, Sicong; Wang, Xiaozeng; Li, Zhao‐Shen; Stone, Gregg W.

doi:10.1016/j.jacc.2021.10.028

Cited by 48 publications

(27 citation statements)

References 35 publications

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“…LPS from the reference H. pylori strain CCUG 17874 (obtained by courtesy of AP. Moran), was prepared by hot phenol–water extraction, purified by proteinase K and RNA-se treatment and ultracentrifugation as previously described [ 49 ]. E. coli LPS derived from the O55:B5 strain (Sigma-Aldrich, Saint Louis, MO, USA), was used as control.…”

Section: Methodsmentioning

confidence: 99%

Accumulation of Deleterious Effects in Gastric Epithelial Cells and Vascular Endothelial Cells In Vitro in the Milieu of Helicobacter pylori Components, 7-Ketocholesterol and Acetylsalicylic Acid

Gajewski

Gawrysiak

Krupa

et al. 2022

IJMS

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The Gastric pathogen Helicobacter pylori (HP) may influence the development of coronary heart disease (CHD). H. pylori induce reactive oxygen species (ROS), which transform cholesterol to 7-ketocholesterol (7-kCh), a CHD risk factor. Acetylsalicylic acid (ASA)—an Anti-aggregation drug used in CHD patients—may increase gastric bleeding and inflammation. We examined whether H. pylori driven ROS effects in the cell cultures of gastric epithelial cells (AGS) and vascular endothelial cells (HUVEC) progress in the milieu of 7-kCh and ASA. Cell cultures, exposed to 7-kCh or ASA alone or pulsed with the H. pylori antigenic complex—Glycine acid extract (GE), urease (UreA), cytotoxin associated gene A (CagA) protein or lipopolysaccharide (LPS), alone or with 7-kCh and ASA—were examined for ROS, apoptosis, cell integrity, interleukin (IL)-8, the activation of signal transducer, the activator of transcription 3 (STAT3), and wound healing. ASA and 7-kCh alone, and particularly in conjunction with H. pylori components, increased the ROS level and the rate of apoptosis, which was followed by cell disintegration, the activation of STAT3, and IL-8 elevation. AGS cells were unable to undergo wound healing. The cell ROS response to H. pylori components may be elevated by 7-kCh and ASA.

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Section: Methodsmentioning

confidence: 99%

Accumulation of Deleterious Effects in Gastric Epithelial Cells and Vascular Endothelial Cells In Vitro in the Milieu of Helicobacter pylori Components, 7-Ketocholesterol and Acetylsalicylic Acid

Gajewski

Gawrysiak

Krupa

et al. 2022

IJMS

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“…It was reported that gastrointestinal adverse reactions were significantly more common than clinically overt bleeding in individuals on antiplatelet therapy. [24][25][26] Elderly age (aged >65 years), history of ulcer or upper gastrointestinal bleeding, Helicobacter pylori infection, aspirin dose, concomitant use of other antithrombotic medications, excessive smoking and drinking were all risk factors for aspirin-related gastrointestinal complications. 27 In the present study, gastrointestinal adverse reactions occurred in 15.73% of patients, with no significant differences between groups at different aspirin dosages, which may be related to the small sample size and bias.…”

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confidence: 99%

Outcomes Associated with 50 mg/d and 100 mg/d Aspirin for the Prevention and Management of Cardiovascular Disease in Chinese Elderly: Single-Center Interim Analysis of a Multicenter, Prospective, Observational Study

Wang¹,

Wang²,

Zheng³

et al. 2022

IJGM

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Purpose Although aspirin can effectively reduce the occurrence of atherothrombosis, it is significantly associated with increased bleeding, with elderly individuals being at increased risk of cardiovascular diseases (CVD) and hemorrhage. This study aims to evaluate the efficacy and safety of aspirin 50 mg/d and 100 mg/d for the prevention and management of CVD in Chinese elderly. Patients and Methods The Low-dose Aspirin for Primary and Secondary Prevention of Cardiovascular Disease in the Elderly Study (LAPIS) is a multicenter, prospective, observational cohort study, this study was a single-center interim analysis of LAPIS. Patients aged ≥60 and required long-term aspirin for primary and secondary prevention of CVD were eligible. From Apr 1, 2019 to Feb 28, 2022, 165 patients who received 50 mg/d aspirin and 261 patients who received 100 mg/d aspirin were included in the study. The incidence of major cardiovascular events (MACEs), bleeding events, and gastrointestinal adverse events were compared between two groups. Results After adjusting for patient characteristics using propensity score matching, aspirin 100 mg/d was associated with increased incidence rates of total bleeding events (28.34 vs.17.25 events/100 patient-years, HR 1.671, 95% CI 1.024–2.712, P = 0.040) and minor bleeding events (27.63 vs.15.92 events/100 patient-years, HR 1.738, 95% CI 1.056–2.861, P = 0.031), whereas the incidence of MACE (6.35 vs 6.65 events/100 patient-years, HR 0.921, 95% CI 0.399–2.127, P = 0.848) and gastrointestinal adverse events (12.73 vs.10.42 events/100 patient-years, HR 1.206, 95% CI 0.623–2.337, P = 0.578) were similar between the two groups. Multivariate Cox analysis identified that aspirin dose (100 mg/d vs. 50 mg/d, HR 1.918, 95% CI 1.137–3.235, P = 0.015), concomitant use of other antiplatelets (HR 1.748, 95% CI 1.009–3.028, P = 0.046) and anticoagulants (HR 2.501, 95% CI 1.287–4.862, P = 0.007) were independently associated with bleeding events. Conclusion 50 mg/d aspirin may be preferred to balance the safety and effectiveness in Chinese individuals over 60 years of age who need long-term aspirin for the prevention and management of CVD. Trial Registration ChiCTR1900021980 (chictr.org.cn). Registered on 19 March 2019.

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“…The difference of the primary and secondary endpoints will be compared in the above two subgroup analyses, respectively. Recently, the OPT-PEACE study [ 22 ] revealed the presence and severity of gastrointestinal mucosal lesions at 6 months or 12 months by magnetically controlled capsule endoscopy in patients receiving 12-month DAPT without PPI after PCI. To date, no study has reported visually evaluating the upper gastrointestinal mucosal injury (including RE) after 6 and 12 months of PPI treatment combined with two different DAPT by EGD yet.…”

Section: Discussionmentioning

confidence: 99%

Proton pump inhibitor in the prevention of upper gastrointestinal mucosal injury associated with dual antiplatelet therapy after coronary artery bypass grafting (DACAB-GI-2): study protocol for a randomized controlled trial

Zhu

Wang

Yang

et al. 2022

Trials

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Background Dual antiplatelet therapy (DAPT) is recommended in secondary prevention after coronary artery bypass grafting (CABG), but it is inevitably associated with the risk of bleeding, of which gastrointestinal bleeding accounts for more than half. Proton pump inhibitors (PPIs) may increase the risk of major cardiovascular adverse events when reducing the risk of upper gastrointestinal bleeding. Therefore, the optimal duration of a PPI in combination with DAPT is unclear. Methods The “Proton Pump Inhibitor Preventing Upper Gastrointestinal Injury in Patients on Dual Antiplatelet Therapy after CABG” (DACAB-GI-2) study is a prospective, single-center, open-label, parallel, randomized controlled trial. A total of 232 eligible subjects who are scheduled or initiated on DAPT (clopidogrel plus aspirin or ticagrelor plus aspirin) for 12 months immediately after CABG will be enrolled and be randomized in a 1:1 ratio to either a 12-month pantoprazole treatment arm or a 1-month treatment arm. The primary outcome is to assess the rate of gastroduodenal erosions and ulcers evaluated by esophagogastroduodenoscopy (EGD) within 12 months after randomization, based on the modified Lanza score. Secondary outcomes include reflux esophagitis and upper gastrointestinal bleeding. Other pre-specified outcomes include major adverse cardiovascular events, graft failure, and all-cause death. Discussion This study aims to compare the efficacy and safety of 12 months and 1 month of pantoprazole treatment in preventing DAPT-related upper gastrointestinal mucosal injury after CABG. Trial registration ClinicalTrials.gov NCT03908593.

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Magnetically Controlled Capsule Endoscopy for Assessment of Antiplatelet Therapy–Induced Gastrointestinal Injury

Cited by 48 publications

References 35 publications

Accumulation of Deleterious Effects in Gastric Epithelial Cells and Vascular Endothelial Cells In Vitro in the Milieu of Helicobacter pylori Components, 7-Ketocholesterol and Acetylsalicylic Acid

Accumulation of Deleterious Effects in Gastric Epithelial Cells and Vascular Endothelial Cells In Vitro in the Milieu of Helicobacter pylori Components, 7-Ketocholesterol and Acetylsalicylic Acid

Outcomes Associated with 50 mg/d and 100 mg/d Aspirin for the Prevention and Management of Cardiovascular Disease in Chinese Elderly: Single-Center Interim Analysis of a Multicenter, Prospective, Observational Study

Proton pump inhibitor in the prevention of upper gastrointestinal mucosal injury associated with dual antiplatelet therapy after coronary artery bypass grafting (DACAB-GI-2): study protocol for a randomized controlled trial

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