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Article: Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding

TitleClopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding
Authors
KeywordsChemicals And Cas Registry Numbers
Issue Date2005
PublisherMassachusetts Medical Society. The Journal's web site is located at http://content.nejm.org/
Citation
New England Journal Of Medicine, 2005, v. 352 n. 3, p. 238-244 How to Cite?
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.
Persistent Identifierhttp://hdl.handle.net/10722/132856
ISSN
2014 Impact Factor: 55.873
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorChan, FKLen_HK
dc.contributor.authorChing, JYLen_HK
dc.contributor.authorHung, LCTen_HK
dc.contributor.authorWong, VWSen_HK
dc.contributor.authorLeung, VKSen_HK
dc.contributor.authorKung, NNSen_HK
dc.contributor.authorHui, AJen_HK
dc.contributor.authorWu, JCYen_HK
dc.contributor.authorLeung, WKen_HK
dc.contributor.authorLee, VWYen_HK
dc.contributor.authorLee, KKCen_HK
dc.contributor.authorLee, YTen_HK
dc.contributor.authorLau, JYWen_HK
dc.contributor.authorTo, KFen_HK
dc.contributor.authorChan, HLYen_HK
dc.contributor.authorChung, SCSen_HK
dc.contributor.authorSung, JJYen_HK
dc.date.accessioned2011-04-04T07:57:29Z-
dc.date.available2011-04-04T07:57:29Z-
dc.date.issued2005en_HK
dc.identifier.citationNew England Journal Of Medicine, 2005, v. 352 n. 3, p. 238-244en_HK
dc.identifier.issn0028-4793en_HK
dc.identifier.urihttp://hdl.handle.net/10722/132856-
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.en_HK
dc.languageengen_US
dc.publisherMassachusetts Medical Society. The Journal's web site is located at http://content.nejm.org/en_HK
dc.relation.ispartofNew England Journal of Medicineen_HK
dc.subjectChemicals And Cas Registry Numbersen_US
dc.subject.meshAgeden_HK
dc.subject.meshAnti-Ulcer Agents - therapeutic useen_HK
dc.subject.meshAspirin - adverse effects - therapeutic useen_HK
dc.subject.meshCardiovascular Diseases - prevention & controlen_HK
dc.subject.meshDouble-Blind Methoden_HK
dc.subject.meshDrug Therapy, Combinationen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHumansen_HK
dc.subject.meshMaleen_HK
dc.subject.meshOmeprazole - therapeutic useen_HK
dc.subject.meshPeptic Ulcer Hemorrhage - chemically induced - prevention & controlen_HK
dc.subject.meshPlatelet Aggregation Inhibitors - adverse effects - therapeutic useen_HK
dc.subject.meshProspective Studiesen_HK
dc.subject.meshProton Pumps - antagonists & inhibitorsen_HK
dc.subject.meshRecurrence - prevention & controlen_HK
dc.subject.meshTiclopidine - analogs & derivatives - therapeutic useen_HK
dc.titleClopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleedingen_HK
dc.typeArticleen_HK
dc.identifier.emailLeung, WK:waikleung@hku.hken_HK
dc.identifier.authorityLeung, WK=rp01479en_HK
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1056/NEJMoa042087en_HK
dc.identifier.pmid15659723en_HK
dc.identifier.scopuseid_2-s2.0-19944426821en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-19944426821&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume352en_HK
dc.identifier.issue3en_HK
dc.identifier.spage238en_HK
dc.identifier.epage244en_HK
dc.identifier.isiWOS:000226370500004-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridChan, FKL=7202586434en_HK
dc.identifier.scopusauthoridChing, JYL=7005086238en_HK
dc.identifier.scopusauthoridHung, LCT=7103351774en_HK
dc.identifier.scopusauthoridWong, VWS=7202525502en_HK
dc.identifier.scopusauthoridLeung, VKS=7102336049en_HK
dc.identifier.scopusauthoridKung, NNS=6603573627en_HK
dc.identifier.scopusauthoridHui, AJ=7102453674en_HK
dc.identifier.scopusauthoridWu, JCY=7409253910en_HK
dc.identifier.scopusauthoridLeung, WK=7201504523en_HK
dc.identifier.scopusauthoridLee, VWY=7402507380en_HK
dc.identifier.scopusauthoridLee, KKC=7501515004en_HK
dc.identifier.scopusauthoridLee, YT=8041471500en_HK
dc.identifier.scopusauthoridLau, JYW=13907867100en_HK
dc.identifier.scopusauthoridTo, KF=7101911940en_HK
dc.identifier.scopusauthoridChan, HLY=16038785900en_HK
dc.identifier.scopusauthoridChung, SCS=19642462800en_HK
dc.identifier.scopusauthoridSung, JJY=24473715000en_HK
dc.identifier.citeulike2994401-

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