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Article: Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding
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TitleClopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding
 
AuthorsChan, FKL1
Ching, JYL1
Hung, LCT1
Wong, VWS1
Leung, VKS2
Kung, NNS2
Hui, AJ1
Wu, JCY1
Leung, WK1
Lee, VWY1
Lee, KKC1
Lee, YT1
Lau, JYW1
To, KF1
Chan, HLY1
Chung, SCS1
Sung, JJY1
 
KeywordsChemicals And Cas Registry Numbers
 
Issue Date2005
 
PublisherMassachusetts Medical Society. The Journal's web site is located at http://content.nejm.org/
 
CitationNew England Journal Of Medicine, 2005, v. 352 n. 3, p. 238-244 [How to Cite?]
DOI: http://dx.doi.org/10.1056/NEJMoa042087
 
AbstractBACKGROUND: Concurrent therapy with a proton-pump inhibitor is a standard treatment for patients receiving aspirin who are at risk for ulcer. Current U.S. guidelines also recommend clopidrogel for patients who have major gastrointestinal intolerance of aspirin. We compared clopidogrel with aspirin plus esomeprazole for the prevention of recurrent bleeding from ulcers in high-risk patients. METHODS: We studied patients who took aspirin to prevent vascular diseases and who presented with ulcer bleeding. After the ulcers had healed, we randomly assigned patients who were negative for Helicobacter pylori to receive either 75 mg of clopidogrel daily plus esomeprazole placebo twice daily or 80 mg of aspirin daily plus 20 mg of esomeprazole twice daily for 12 months. The end point was recurrent ulcer bleeding. RESULTS: We enrolled 320 patients (161 patients assigned to receive clopidogrel and 159 to receive aspirin plus esomeprazole). Recurrent ulcer bleeding occurred in 13 patients receiving clopidogrel and 1 receiving aspirin plus esomeprazole. The cumulative incidence of recurrent bleeding during the 12-month period was 8.6 percent (95 percent confidence interval, 4.1 to 13.1 percent) among patients who received clopidogrel and 0.7 percent (95 percent confidence interval, 0 to 2.0 percent) among those who received aspirin plus esomeprazole (difference, 7.9 percentage points; 95 percent confidence interval for the difference, 3.4 to 12.4; P=0.001). CONCLUSIONS: Among patients with a history of aspirin-induced ulcer bleeding whose ulcers had healed before they received the study treatment, aspirin plus esomeprazole was superior to clopidogrel in the prevention of recurrent ulcer bleeding. Our finding does not support the current recommendation that patients with major gastrointestinal intolerance of aspirin be given clopidogrel. Copyright © 2005 Massachusetts Medical Society.
 
ISSN0028-4793
2013 Impact Factor: 54.420
 
DOIhttp://dx.doi.org/10.1056/NEJMoa042087
 
ISI Accession Number IDWOS:000226370500004
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorChan, FKL
 
dc.contributor.authorChing, JYL
 
dc.contributor.authorHung, LCT
 
dc.contributor.authorWong, VWS
 
dc.contributor.authorLeung, VKS
 
dc.contributor.authorKung, NNS
 
dc.contributor.authorHui, AJ
 
dc.contributor.authorWu, JCY
 
dc.contributor.authorLeung, WK
 
dc.contributor.authorLee, VWY
 
dc.contributor.authorLee, KKC
 
dc.contributor.authorLee, YT
 
dc.contributor.authorLau, JYW
 
dc.contributor.authorTo, KF
 
dc.contributor.authorChan, HLY
 
dc.contributor.authorChung, SCS
 
dc.contributor.authorSung, JJY
 
dc.date.accessioned2011-04-04T07:57:29Z
 
dc.date.available2011-04-04T07:57:29Z
 
dc.date.issued2005
 
dc.description.abstractBACKGROUND: Concurrent therapy with a proton-pump inhibitor is a standard treatment for patients receiving aspirin who are at risk for ulcer. Current U.S. guidelines also recommend clopidrogel for patients who have major gastrointestinal intolerance of aspirin. We compared clopidogrel with aspirin plus esomeprazole for the prevention of recurrent bleeding from ulcers in high-risk patients. METHODS: We studied patients who took aspirin to prevent vascular diseases and who presented with ulcer bleeding. After the ulcers had healed, we randomly assigned patients who were negative for Helicobacter pylori to receive either 75 mg of clopidogrel daily plus esomeprazole placebo twice daily or 80 mg of aspirin daily plus 20 mg of esomeprazole twice daily for 12 months. The end point was recurrent ulcer bleeding. RESULTS: We enrolled 320 patients (161 patients assigned to receive clopidogrel and 159 to receive aspirin plus esomeprazole). Recurrent ulcer bleeding occurred in 13 patients receiving clopidogrel and 1 receiving aspirin plus esomeprazole. The cumulative incidence of recurrent bleeding during the 12-month period was 8.6 percent (95 percent confidence interval, 4.1 to 13.1 percent) among patients who received clopidogrel and 0.7 percent (95 percent confidence interval, 0 to 2.0 percent) among those who received aspirin plus esomeprazole (difference, 7.9 percentage points; 95 percent confidence interval for the difference, 3.4 to 12.4; P=0.001). CONCLUSIONS: Among patients with a history of aspirin-induced ulcer bleeding whose ulcers had healed before they received the study treatment, aspirin plus esomeprazole was superior to clopidogrel in the prevention of recurrent ulcer bleeding. Our finding does not support the current recommendation that patients with major gastrointestinal intolerance of aspirin be given clopidogrel. Copyright © 2005 Massachusetts Medical Society.
 
dc.description.naturelink_to_subscribed_fulltext
 
dc.identifier.citationNew England Journal Of Medicine, 2005, v. 352 n. 3, p. 238-244 [How to Cite?]
DOI: http://dx.doi.org/10.1056/NEJMoa042087
 
dc.identifier.citeulike2994401
 
dc.identifier.doihttp://dx.doi.org/10.1056/NEJMoa042087
 
dc.identifier.epage244
 
dc.identifier.isiWOS:000226370500004
 
dc.identifier.issn0028-4793
2013 Impact Factor: 54.420
 
dc.identifier.issue3
 
dc.identifier.pmid15659723
 
dc.identifier.scopuseid_2-s2.0-19944426821
 
dc.identifier.spage238
 
dc.identifier.urihttp://hdl.handle.net/10722/132856
 
dc.identifier.volume352
 
dc.languageeng
 
dc.publisherMassachusetts Medical Society. The Journal's web site is located at http://content.nejm.org/
 
dc.publisher.placeUnited States
 
dc.relation.ispartofNew England Journal of Medicine
 
dc.relation.referencesReferences in Scopus
 
dc.subject.meshAged
 
dc.subject.meshAnti-Ulcer Agents - therapeutic use
 
dc.subject.meshAspirin - adverse effects - therapeutic use
 
dc.subject.meshCardiovascular Diseases - prevention & control
 
dc.subject.meshDouble-Blind Method
 
dc.subject.meshDrug Therapy, Combination
 
dc.subject.meshFemale
 
dc.subject.meshHumans
 
dc.subject.meshMale
 
dc.subject.meshOmeprazole - therapeutic use
 
dc.subject.meshPeptic Ulcer Hemorrhage - chemically induced - prevention & control
 
dc.subject.meshPlatelet Aggregation Inhibitors - adverse effects - therapeutic use
 
dc.subject.meshProspective Studies
 
dc.subject.meshProton Pumps - antagonists & inhibitors
 
dc.subject.meshRecurrence - prevention & control
 
dc.subject.meshTiclopidine - analogs & derivatives - therapeutic use
 
dc.subjectChemicals And Cas Registry Numbers
 
dc.titleClopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding
 
dc.typeArticle
 
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<contributor.author>Leung, VKS</contributor.author>
<contributor.author>Kung, NNS</contributor.author>
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<contributor.author>Lau, JYW</contributor.author>
<contributor.author>To, KF</contributor.author>
<contributor.author>Chan, HLY</contributor.author>
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<description.abstract>BACKGROUND: Concurrent therapy with a proton-pump inhibitor is a standard treatment for patients receiving aspirin who are at risk for ulcer. Current U.S. guidelines also recommend clopidrogel for patients who have major gastrointestinal intolerance of aspirin. We compared clopidogrel with aspirin plus esomeprazole for the prevention of recurrent bleeding from ulcers in high-risk patients. METHODS: We studied patients who took aspirin to prevent vascular diseases and who presented with ulcer bleeding. After the ulcers had healed, we randomly assigned patients who were negative for Helicobacter pylori to receive either 75 mg of clopidogrel daily plus esomeprazole placebo twice daily or 80 mg of aspirin daily plus 20 mg of esomeprazole twice daily for 12 months. The end point was recurrent ulcer bleeding. RESULTS: We enrolled 320 patients (161 patients assigned to receive clopidogrel and 159 to receive aspirin plus esomeprazole). Recurrent ulcer bleeding occurred in 13 patients receiving clopidogrel and 1 receiving aspirin plus esomeprazole. The cumulative incidence of recurrent bleeding during the 12-month period was 8.6 percent (95 percent confidence interval, 4.1 to 13.1 percent) among patients who received clopidogrel and 0.7 percent (95 percent confidence interval, 0 to 2.0 percent) among those who received aspirin plus esomeprazole (difference, 7.9 percentage points; 95 percent confidence interval for the difference, 3.4 to 12.4; P=0.001). CONCLUSIONS: Among patients with a history of aspirin-induced ulcer bleeding whose ulcers had healed before they received the study treatment, aspirin plus esomeprazole was superior to clopidogrel in the prevention of recurrent ulcer bleeding. Our finding does not support the current recommendation that patients with major gastrointestinal intolerance of aspirin be given clopidogrel. Copyright &#169; 2005 Massachusetts Medical Society.</description.abstract>
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<subject.mesh>Cardiovascular Diseases - prevention &amp; control</subject.mesh>
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<subject.mesh>Platelet Aggregation Inhibitors - adverse effects - therapeutic use</subject.mesh>
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Author Affiliations
  1. Prince of Wales Hospital Hong Kong
  2. United Christian Hospital Hong Kong