Upper gastrointestinal mucosal injury associated with ticagrelor plus aspirin, ticagrelor alone, or aspirin alone at 1‐year after coronary artery bypass grafting

Abstract

Background and Aim: The presence and severity of upper gastrointestinal mucosal lesions have not been evaluated using esophagogastroduodenoscopy (EGD) in patients receiving ticagrelor plus aspirin or alone after myocardial revascularization. We assessed upper gastrointestinal mucosal injury and the use of proton pump inhibitors (PPIs) in patients receiving 1 year of antiplatelet therapy after coronary artery bypass grafting (CABG). Methods: In this single-center prospective substudy of a randomized trial, 231 patients completing 1-year antiplatelet therapy (ticagrelor 90 mg twice daily plus aspirin 100 mg once daily, ticagrelor 90 mg twice daily, or aspirin 100 mg once daily, in 81, 80, and 70 patients, respectively) after CABG underwent 13 C urea breath testing and EGD. Gastroduodenal lesions were assessed by modified Lanza score, and reflux esophagitis was evaluated according to Los Angeles classification. Additionally, at least one ulcer ≥ 5 mm was separately analyzed. Results: Among 231 patients, EGD showed 28 (12.1%) with ulcers ≥ 5 mm, which were detected in 13.6% (11/81) of ticagrelor plus aspirin recipients, 8.8% (7/80) of ticagrelor recipients, and 14.3% (10/70) of aspirin recipients, and 24 (10.4%) had reflux esophagitis. Eighty-eight (38.1%) patients had a positive 13 C urea breath testing after 1 year of treatment, and one patient received eradication therapy during follow up. Nineteen (8.2%) patients received a PPI for ≥ 6 months. Conclusions: Severe upper gastrointestinal mucosal lesions were more frequently observed in patients treated with ticagrelor plus aspirin and aspirin monotherapy than in patients treated with ticagrelor monotherapy for 1 year post-CABG. Prophylactic use of PPIs might be inadequate.

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

“…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.…”

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

“…It was recorded at 1, 3, 6, and 12 months post-CABG. Data of both upper gastrointestinal mucosal injury assessed by EGD and H. pylori infection detected by 13 C urea breath test were obtained only at 1 year post-CABG, not at baseline [ 12 ]. In the present study (DACAB-GI-2), 232 subjects on DAPT after CABG will be randomized into two treatment groups (12- vs. 1-month treatment of pantoprazole); 13 C urea breath test is done before enrollment and EGD is performed at 6 and 12 months after randomization, respectively.…”

“…The present study includes two subgroup analyses, one is H. pylori infection status and the other is DAPT treatment. The results of our DACAB-GI-1 study [ 12 ] showed that the positive rate of H. pylori in patients receiving 1 year of antiplatelet therapy after CABG was 38.5%. After the study is completed, patients will be divided into the H. pylori -positive group and the H. pylori -negative group based on the results of the 13 C urea breath test before enrollment; in addition, patients will be categorized into the clopidogrel plus aspirin group and the ticagrelor plus aspirin group according to their DAPT regimen after CABG.…”

“…Our previous study (DACAB-GI-1) was a single-center randomized controlled trial (RCT) focused on upper gastrointestinal mucosal injury associated with ticagrelor plus aspirin, ticagrelor alone, or aspirin alone at 1-year post-CABG. The results showed that patients with a history of peptic ulcer and/or gastrointestinal bleeding received more attention, of which 77.7% (7/9) received PPI combination treatment for ≥6 months, while among the patients who received 1 year of ticagrelor plus aspirin therapy after CABG, only 9.9% (8/81) received PPI combination treatment for ≥6 months [ 12 ]. The upper gastrointestinal mucosal injury associated with DAPT in patients without a history of peptic ulcer and/or gastrointestinal bleeding needed to be further investigated.…”

Aspirin Repurposing in Folate-Decorated Nanoparticles: Another Way to Target Breast Cancer

“…To overcome aspirin's gastrointestinal mucosal damage (Gao et al, 2019;Tang et al, 2020), MNPs were loaded with aspirin to treat breast cancer and the cytotoxic effects were examined while comparing aspirin and aspirin-loaded MNPs through the MTT assay. We observed that aspirinloaded MNPs (MNP-Asp-PD-PG-F) show 15-25% stronger cytotoxic effects against cancer cells than the free drug (Figure 3).…”