Gastrointestinal adverse events after dual antiplatelet therapy: clopidogrel is
safer than ticagrelor, but prasugrel data are lacking or inconclusive.
Author(s): Serebruany VL(1), Dinicolantonio JJ, Can MM, Pershukov IV, Kuliczkowski W.
Affiliation(s): Author information:
(1)Johns Hopkins University, Baltimore, MD, USA. heartdrug@aol.com
Publication date & source: 2013, Cardiology. , 126(1):35-40
Current guidelines offer a choice of P2Y12 receptor antagonist among clopidogrel,
prasugrel or ticagrelor on top of aspirin (ASA) for dual antiplatelet therapy
(DAPT) in patients after acute coronary syndromes (ACS). However, the comparative
risks of gastrointestinal (GI) adverse events during DAPT are not clear. Two
large ACS trials (TRITON and PLATO) provide a valuable opportunity to directly
match the risks of GI complications among current antiplatelet regimens. We
compared the rates of GI adverse events after prasugrel and ticagrelor versus
clopidogrel based on the Food and Drug Administration (FDA) clinical safety
reviews. When compared with ticagrelor, clopidogrel is safer with regard to
GI-related risks including fewer overall GI/anal bleeding events and spontaneous
GI hemorrhagic episodes, less nausea, vomiting, dyspepsia and diarrhea, and a
lower rate of presence of Helicobacter pylori. Among GI symptoms, only
constipation was more common after clopidogrel than following ticagrelor. There
were extrahepatic risks observed with ticagrelor but not with prasugrel when
compared to clopidogrel. Prasugrel unquestionably caused more bleeding from the
GI tract and GI malignancies than clopidogrel. However, the entire spectrum of GI
effects of prasugrel is much less well known and mostly based on sponsor analysis
rather than FDA-verified numbers. Among 3 DAPT options on top of ASA, clopidogrel
seems to represent the safest alternative, although comprehensive data on direct
prasugrel-associated GI effects are lacking or inconclusive.
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