Effect of Dual Antiplatelet Therapy on Gastric Mucosa in Stroke Patients (Endoscopic Evaluation)
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- Category: Vol. 78, June 2010
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Effect of Dual Antiplatelet Therapy on Gastric Mucosa in Stroke Patients (Endoscopic Evaluation),AMR EL-HADIDY, HAZEM HOSAM EL-DIN, HAMDY SABER and ABD-EL-AZIZ MUSTAFA
Abstract
Introduction: Our study was conducted prospectively on twenty patients with acute non-hemorrhagic cerebro-vascular stroke in the period from December 2007 to December 2008 aiming at evaluating and comparing gastric complications of dual antiplatelet therapy Vs Monoantiplatelet therapy using upper GI endoscopy.
Methods: Patients were divided into 2 equal groups (Group A, maintained on Aspocid 150mg & group B maintained on Aspocid 150mg plus Clopidogrel 75mg). Both groups were maintained on antiplatelets for 1 week and evaluated endo-scopically twice, according to Rypins grading of gastric mucosa [1], once upon admission and another follow-up after a week of initiating antiplatelet therapy to detect gastric complications.
Results: There was no significant difference as regard age of both groups (p-value 0.496). Sex had non significant difference (p-value 0.65). There was a non significant difference between the two groups regarding diabetes mellitus, hyper-tension, smoking, previous CVA and dyslipidemia. A non significant difference between both groups regarding neuro-logical findings (p-value 0.82). Regarding Glasgow Coma Scale (GCS), there was non significant difference between the two groups (p-value 0.125). A non significant difference between the two groups regarding presence of gastric symptoms (p-value 0.582). As regards previous usage of antiplatelets, there was a significant difference between the two groups (p-value 0.007). In group A, Ninety percent of patients had the same endoscopic findings (grading 0-3) at day 0 and day 7 and only 10% of patients deteriorated, regarding endoscopic findings, from grade 0 to grade 7. In group B, Forty percent of patients had the same endoscopic gastric findings (grading 0-4) and 60% deteriorated-10% of them progressed from grade 1 to 7,10% progressed from grade 2 to 7,20% progressed from grade 3 to 7,10% progressed from grade 0 to 3 and 10% progressed from grade 3 to 6. There was statistically significant difference in both groups with a p-value 0.0198 that indicated that gastric complication increased markedly with usage of dual antiplatelets drugs in relation to Monoantiplatelet drugs. A non significant difference between the two groups regarding the outcome (mortality) (p-value 1.0).
Conclusion: The combination of dual antiplatelet therapy (Aspirin & clopidogrel) increased gastric complications in comparison to Monoantiplatelet therapy (Aspirin) alone and so it is not recommended.