Magnetically Controlled Capsule Endoscopy for Assessment of Antiplatelet Therapy-Induced Gastrointestinal Injury

作者：Han, Yaling^*; Liao, Zhuan; Li, Yi; Zhao, Xianxian; Ma, Shuren; Bao, Dan; Qiu, Miaohan; Deng, Jie; Wang, Jinhai; Qu, Peng; Jiang, Chunmeng; Jia, Shaobin; Yang, Shaoqi; Ru, Leisheng; Feng, Jia; Gao, Wei; Huang, Yonghui; Tao, Ling; Han, Ying; Yang, Kan; Wang, Xiaoyan; Zhang, Wenjuan; Wang, Bangmao; Li, Yue; Yang, Youlin; Li, Junxia; Sheng, Jiangqiu; Ma, Yitong; Cui, Min; Ma, Sicong; Wang, Xiaozeng; Li, Zhaoshen^*; Stone, Gregg W.

来源：Journal of the American College of Cardiology, 2022, 79(2): 116-128.

DOI：10.1016/j.jacc.2021.10.028

• antiplatelet therapy
• endoscopy
• gastrointestinal injury
• percutaneous coronary intervention

BACKGROUND Gastrointestinal bleeding is the most frequent major complication of antiplatelet therapy. In patients at tow bleeding risk, however, clinically overt gastrointestinal bleeding is relatively uncommon. @@@ OBJECTIVES The authors sought to assess the effects of different antiplatelet regimens on gastrointestinal mucosal injury by means of a novel magnetically controlled capsule endoscopy system in patients at tow bleeding risk. @@@ METHODS Patients (n 505) undergoing percutaneous coronary intervention in whom capsule endoscopy demonstrated no ulcerations or bleeding (although erosions were permitted) after 6 months of dual antiplatelet therapy (DAPT) were randomly assigned to aspirin plus placebo (n 168), clopidogrel plus placebo (n = 169), or aspirin plus clopidogrel (n 168) for an additional 6 months. The primary endpoint was the incidence of gastrointestinal mucosal injury (erosions, ulceration, or bleeding) at 6-month or 12-month capsule endoscopy. @@@ RESULTS Gastrointestinal mucosal injury through 12 months was less with single antiplatelet therapy (SAPT) than with DAPT (94.3% vs 99.2%; P = 0.02). Aspirin and clopidogrel monotherapy had similar effects. Among 68 patients without any gastrointestinal injury at randomization (including no erosions), SAPT compared with DAPT caused less gastrointestinal injury (68.1% vs 95.2%; P = 0.006), including fewer new ulcers (8.5% vs 38.1%; P = 0.009). Clinical gastrointestinal bleeding from 6 to 12 months was less with SAPT than with DAPT (0.6% vs 5.4%; P = 0.001). @@@ CONCLUSIONS Despite being at tow risk of bleeding, nearly alt patients receiving antiplatelet therapy developed gastrointestinal injury, although overt bleeding was infrequent. DAPT for 6 months followed by SAPT with aspirin or dopidogret from 6 to 12 months resulted in less gastrointestinal mucosat injury and clinical bleeding compared with DAPT through 12 months. (OPT-PEACE [Optimal Antiplatelet Therapy for

• 单位
  1; 哈尔滨医科大学; 北京大学; 西安交通大学