1. Magnetically Controlled Capsule Endoscopy for Assessment of Antiplatelet Therapy–Induced Gastrointestinal Injury
- Author
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Xiaozeng Wang, Ying Han, Wei Gao, Jia Feng, Zhuan Liao, Xiaoyan Wang, Peng Qu, Yi-Tong Ma, Miaohan Qiu, Gregg W. Stone, Shuren Ma, Jun-xia Li, Kan Yang, Jie Deng, Leisheng Ru, Zhao-Shen Li, Youlin Yang, Jiangqiu Sheng, Jinhai Wang, Shaobin Jia, Yue Li, Yi Li, Yaling Han, Sicong Ma, Ling Tao, Shaoqi Yang, Wenjuan Zhang, Min Cui, Dan Bao, Chunmeng Jiang, Yonghui Huang, Bangmao Wang, and Xianxian Zhao
- Subjects
Male ,medicine.medical_specialty ,Gastrointestinal bleeding ,Randomization ,medicine.medical_treatment ,Placebo ,Capsule Endoscopy ,Gastroenterology ,law.invention ,Percutaneous Coronary Intervention ,Capsule endoscopy ,law ,Internal medicine ,medicine ,Humans ,Intestinal Mucosa ,Ulcer ,Aged ,Aspirin ,medicine.diagnostic_test ,business.industry ,Dual Anti-Platelet Therapy ,Percutaneous coronary intervention ,Clopidogrel ,medicine.disease ,Endoscopy ,Gastric Mucosa ,Female ,Gastrointestinal Hemorrhage ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
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).
- Published
- 2022