Prevention Of Low Cose-Acetylsaliclic Acid-Associated Gsatric/Duodenal Injuries With Esomeprozole And Their Interaction

BackgroundWith the ageing of the population of Chinas social progress,Cardiovascular and Cerebrovascular diseases have become the leading causeof death of Chinese residents.Anticoagulanttherapy is widely used in Cardiovascular and Cerebrovascular diseases. Aspirin as inhibit platelet drug has usedclinically more than 100 years. Low-dose aspirin can prevent Cardiovascular and Cerebrovascular diseases, already have evidence of evidence-based medicine. With the role of antiplatelet aggregation, Aspirin also cause gastrointestinal mucosal injury because of its suppression of the protective effects of physiological COX. Our data have indicated that low-dose aspirin can cause gastric mucosal nijury in the clinical imperceptible. The gastric mucosal injury by endoscopic surveillance can be found in 5%-20% of the patients had mucosal ulcer, the incidence of gastric ulcer is 12%-30%, the incidence of duodenal ulcer is 2%-19%, the risk of ulcer complications (bleeding,perforation) also increase 4-6 times. Its reported that taking-aspirin in the first month is the greatest risk of ulcer complications. Some previous studies focused on the relationship taking aspirin and gastric mucoal injury. There is less studies on the patients taking proton punp inhibitors at the same time.AimLow-dose aspirin is effective for the prevention of cardiovascular and cerebrovascular events, but some of these patients are at increased risk of GI adverse events. To determine whether esomeprazole reduces the incidence of the gastroduodenal injuries associated with low-dose aspirin,and to explore the effect of esomeprazole treatment on aspirin anti-platelet actionMethods95 patiente were randomly to receive aspirin enteric-coated tablets 100mg/ d or esomeprazole tablets 20 mg/d combined with aspirin enteric-coated tablets 100 mg/d. Endoscopic findings such as ulcers and flat erosions were assessed as mucosal injuries.The platelet aggregation rate was examined before and 28 days after administration. The differences of the platelet aggregation rate were compared.ResultsMucosal injuries were found in 29 of 47 (61.7%) aspirin users and five of 48 (10.4%) patients taking combination drugs. There were significantly more mucosal injuries among low-dose aspirin users than among the patients taking combination drugs (P<0.05). Gastroduodenal ulcers were found in 8 of 47 (17%) low-dose aspirin users compared with one of 48 (2.31%) the patients taking combination drugs. After administration with aspirin enteric-coated tablets or esomeprazole associated with aspirin, the platelet aggregation rate was reduced significantly (P<0.05).Conclusionesomeprazole is effective in prevention the occurrence of gastric/duodenal ulcers as well as upper GI symptoms in patients at increased risk of ulcer development during low-dose ASA therapy.esomeprazole did not affect the anti-platelet aggregation effect induced by aspirin. Further trials with larger number are needed to be confirmed these results.