No Differences in Gastrointestinal Bleeding Risk among Clopidogrel-, Ticagrelor-, or Prasugrel-Based Dual Antiplatelet Therapy

The risk for gastrointestinal bleeding from dual antiplatelet therapy (DAPT) with new antiplatelets (prasugrel/ticagrelor) compared to clopidogrel is unclear. Aim: To determine the risk and type of major (gastrointestinal bleeding requiring hospitalization) and minor (anemia and iron deficiency) gastrointestinal events with different types of DAPT. Methods: Retrospective observational cohort study of patients who started DAPT after percutaneous coronary intervention. Follow-up was censored after 12 months of DAPT, when a major gastrointestinal event occurred, or when DAPT was discontinued. Results: Among 1,327 patients (54.03% were treated with clopidogrel-based DAPT, 38.13% with ticagrelor-based DAPT, and 7.84% with prasugrel-based DAPT), 29.5% had at least one gastrointestinal event. Patients taking clopidogrel-DAPT were older, with more comorbidities, and higher gastrointestinal risk compared to those taking other DAPT regimens. Adjusted hazard ratios (HRs) showed no between-group differences in the risk for major (clopidogrel vs. new antiplatelets: HR 0.996; 95% confidence interval 0.497–1.996) and minor (HR 0.920; 0.712–1.189) gastrointestinal events. Most patients received proton pump inhibitors while on DAPT (93.3%) and after withdrawal (83.2%). Conclusion: Prasugrel- or ticagrelor-based DAPT was not associated with increased gastrointestinal bleeding risk when compared to clopidogrel-DAPT. New antiplatelets do not necessarily need to be restricted to patients with low gastrointestinal risk.

Gastrointestinal risk factors for anemia in children with celiac disease

With oral intake, iron absorption in patients with celiac disease (CD) is reduced due to the decreased absorption surface of the atrophic small intestine mucous membrane. Besides, there are additional risk factors for anemia whose mechanisms are unclear.The aimof this study was to evaluate gastrointestinal risk factors for anemia in children. Materialsand methods.The first group consisted of 58 children with newly diagnosed CD who did not adhere to the gluten-free diet(GFD). The second group included 49 children with CD who hasnt been adhering to the GFD. The third group included 69children with chronic gastritis (CG) without CD. In addition to the standard examination, which includes the determination of antibodies to tissue transglutaminase and histological examination of the duodenum mucous membrane, a histological evaluation of the gastric mucosa, determination of pepsinogen 1 and 2 and their ratio, antibodies to Castles intrinsic factor were performed. Results.The mean level of hemoglobin in the group 1114,71120,10125,50g/l, in the group 2124,37128,74133,10g/l, in the group 3130,12133,78137,43g/l (p1,2=0.013;p1,3=0,000;p2,3=0.083). A correlation analysis of the hemoglobin level and morphological parameters of the duodenal mucosa among the studied patients revealed an inverse moderate correlation between the hemoglobin level and the degree of the small intestinal atrophy according to Marshr=0.331,p=0,000, crypt depthr=0,439,p=0,000, and a moderate direct with the ratio of villi:cryptr=0.417,p=0.000, with the height of the villir=0.366,p=0,000. Additionally, a moderate direct correlation between the level of hemoglobin and the number of parietal cells was found to ber=0.354,p=0.037. In group 1, a significant inverse correlation between the level of hemoglobin and the level of antibodies to Castles factorr=0.529,p=0.006, was obtained for the level of antibodies in the Castles factor. Conclusion.Autoimmune gastritis may be an additional risk factor in combination with malabsorption, as a possible cause of anemia in children with CD.