Single antiplatelet therapy causes less GI injury, bleeding than DAPT

Gastrointestinal (GI) injury has developed in almost all patients receiving antiplatelet therapy despite being at low risk of bleeding, reveals a study, noting that overt bleeding is rare.

Of note, dual antiplatelet therapy (DAPT) for 6 months followed by single antiplatelet therapy (SAPT) with aspirin or clopidogrel from 6 to 12 months results in less GI mucosal injury and clinical bleeding relative to DAPT through 12 months.

A team of investigators randomized 505 patients undergoing percutaneous coronary intervention in whom capsule endoscopy demonstrated no ulcerations or bleeding (although erosions were permitted) after 6 months of DAPT to aspirin plus placebo (n=168), clopidogrel plus placebo (n=169), or aspirin plus clopidogrel (n=168) for an additional 6 months.

The incidence of GI mucosal injury (ie, erosions, ulceration, or bleeding) at 6- or 12-month capsule endoscopy was the primary endpoint.

SAPT resulted in less GI mucosal injury though 12 months compared with DAPT (94.3 percent vs 99.2 percent; p=0.02). Similar effects were observed with aspirin and clopidogrel monotherapy.

SAPT also led to less GI injury (68.1 percent vs 95.2 percent; p=0.006) and fewer new ulcers (8.5 percent vs 38.1 percent; p=0.009) than DAPT among patients without any GI injury at randomization, including no erosions (n=68).

In addition, there was less clinical GI bleeding from 6 to 12 months with SAPT than with DAPT (0.6 percent vs 5.4 percent; p=0.001).

“GI bleeding is the most frequent major complication of antiplatelet therapy,” the investigators said. “In patients at low bleeding risk, however, clinically overt gastrointestinal bleeding is relatively uncommon.”