General Hospital of Northern Theater Command, Shenyang, China.
Changhai Hospital of Navy Military Medical University, Shanghai, China.
J Am Coll Cardiol. 2022 Jan 18;79(2):116-128. doi: 10.1016/j.jacc.2021.10.028. Epub 2021 Nov 6.
Gastrointestinal bleeding is the most frequent major complication of antiplatelet therapy. In patients at low bleeding risk, however, clinically overt gastrointestinal bleeding is relatively uncommon.
The authors sought to assess the effects of different antiplatelet regimens on gastrointestinal mucosal injury by means of a novel magnetically controlled capsule endoscopy system in patients at low bleeding risk.
Patients (n = 505) undergoing percutaneous coronary intervention in whom capsule endoscopy demonstrated no ulcerations or bleeding (although erosions were permitted) after 6 months of dual antiplatelet therapy (DAPT) were randomly assigned to aspirin plus placebo (n = 168), clopidogrel plus placebo (n = 169), or aspirin plus clopidogrel (n = 168) for an additional 6 months. The primary endpoint was the incidence of gastrointestinal mucosal injury (erosions, ulceration, or bleeding) at 6-month or 12-month capsule endoscopy.
Gastrointestinal mucosal injury through 12 months was less with single antiplatelet therapy (SAPT) than with DAPT (94.3% vs 99.2%; P = 0.02). Aspirin and clopidogrel monotherapy had similar effects. Among 68 patients without any gastrointestinal injury at randomization (including no erosions), SAPT compared with DAPT caused less gastrointestinal injury (68.1% vs 95.2%; P = 0.006), including fewer new ulcers (8.5% vs 38.1%; P = 0.009). Clinical gastrointestinal bleeding from 6 to 12 months was less with SAPT than with DAPT (0.6% vs 5.4%; P = 0.001).
Despite being at low risk of bleeding, nearly all patients receiving antiplatelet therapy developed gastrointestinal injury, although overt bleeding was infrequent. DAPT for 6 months followed by SAPT with aspirin or clopidogrel from 6 to 12 months resulted in less gastrointestinal mucosal injury and clinical bleeding compared with DAPT through 12 months. (OPT-PEACE [Optimal Antiplatelet Therapy for Prevention of Gastrointestinal Injury Evaluated by Ankon Magnetically Controlled Capsule Endoscopy]; NCT03198741).
胃肠道出血是抗血小板治疗最常见的主要并发症。然而，在低出血风险的患者中，临床上明显的胃肠道出血相对少见。
作者通过新型磁控胶囊内镜系统评估不同抗血小板方案对低出血风险患者胃肠黏膜损伤的影响。
在接受经皮冠状动脉介入治疗的患者中，505 例患者在接受 6 个月的双联抗血小板治疗（DAPT）后行胶囊内镜检查，结果未见溃疡或出血（尽管允许有糜烂），随后被随机分配至阿司匹林+安慰剂组（n=168）、氯吡格雷+安慰剂组（n=169）或阿司匹林+氯吡格雷组（n=168），继续进行 6 个月的治疗。主要终点为 6 个月或 12 个月胶囊内镜检查时胃肠道黏膜损伤（糜烂、溃疡或出血）的发生率。
12 个月时，单药抗血小板治疗（SAPT）组的胃肠道黏膜损伤发生率低于 DAPT 组（94.3% vs 99.2%；P=0.02）。阿司匹林和氯吡格雷单药治疗的效果相似。在随机分组时无任何胃肠道损伤（包括无糜烂）的 68 例患者中，SAPT 组较 DAPT 组胃肠道损伤更少（68.1% vs 95.2%；P=0.006），新发溃疡更少（8.5% vs 38.1%；P=0.009）。6 至 12 个月时，SAPT 组较 DAPT 组临床胃肠道出血更少（0.6% vs 5.4%；P=0.001）。
尽管出血风险较低，但几乎所有接受抗血小板治疗的患者都出现了胃肠道损伤，尽管明显出血并不常见。DAPT 治疗 6 个月后，在 6 至 12 个月期间改为阿司匹林或氯吡格雷的 SAPT 治疗与 12 个月时的 DAPT 相比，胃肠道黏膜损伤和临床出血更少。（OPT-PEACE [通过 Ankon 磁控胶囊内镜评估的最佳抗血小板治疗预防胃肠道损伤]；NCT03198741）。
