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- W2472592040 abstract "upper GI tract within 12 weeks of initiating aspirin therapy will reveal an ulcer in 7% to 10% of patients, and erosive disease in up to 47% of patients. The mucosal toxicity of aspirin is compounded by its antithrombotic effect. Inhibition of thromboxane A2 leads to decreased platelet aggregation and prolongation of bleeding time. Low-dose aspirin (166 mg/d) is associated wit ha2t o 4-fold increased risk of upper GI hemorrhage. Factors thought to increase this risk further include old age, history of peptic ulcer disease, Helicobacter pylori infection, chronic renal failure, diabetes mellitus, and concomitant use of other antiplatelet agents, anticoagulants, or nonsteroidal anti-inflammatory drugs. The thienopyridine clopidogrel is a commonly used antiplatelet agent that inhibits platelet aggregation by irreversibly antagonizing adenosine diphosphate. The use of clopidogrel alone increases the risk of GI hemorrhage, especially in patients with a history of peptic ulcer disease. DAT with combination aspirin and clopidogrel increases the incidence of GI hemorrhage as compared with either agent alone. Data from the Management of A Therothrombosis With Clopidogrel in High Risk Patients (MATCH) and Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) studies show that the risk of GI hemorrhage within the first 30 days of DAT is 1.3%, and increases to 12% in patients with a prior history of peptic ulcer disease or GI hemorrhage. Not only are patients using DAT at high risk of developing adverse GI events, they are also at increased risk of poor outcomes because of their underlying medical conditions. The challenge for the clinician is to adequately manage the bleeding event while minimizing the risk of cardiovascular complications associated with acute blood loss, withholding antiplatelet agents, and sedation administered during endoscopy." @default.
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- W2472592040 date "2011-01-01" @default.
- W2472592040 modified "2023-09-26" @default.
- W2472592040 title "EDUCATION PRACTICE Acute Upper Gastrointestinal Hemorrhage in an Elderly Woman Taking Aspirin and Clopidogrel" @default.
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