What Should I Do If I Have To Take Aspirin

If I Have Stomach Problems?

Since aspirin has damage to the stomach, can switching to clopidogrel reduce the damage to the stomach?

Introduction

Aspirin is an important drug to prevent cardiovascular and cerebrovascular diseases, but it is not uncommon for peptic ulcers and bleeding caused by medication in clinical practice. How to use aspirin safely is very important. Is it safer to change aspirin to clopidogrel?

Aspirin is an important drug to prevent cardiovascular and cerebrovascular diseases. It is the most commonly used drug in clinical practice. The most common adverse reaction is gastrointestinal injury, which can cause epigastric discomfort, fullness, pain, indigestion, anorexia, nausea, vomiting, etc. Symptoms, long-term use of aspirin can cause gastroduodenal erosion, ulcers, bleeding, perforation, etc. It is important to pay attention to the damage of aspirin to the gastrointestinal tract, correctly assess the risk of its digestive tract, and prevent it!

Pay Attention To The Damage Of Aspirin To The Gastrointestinal Tract

Oral aspirin can directly damage the gastric mucosa, but more importantly, the absorption of aspirin can inhibit the synthesis of endogenous prostaglandins. Prostaglandins are an important protective factor for the gastric mucosa and are very important for maintaining the gastric mucosal barrier function. Due to the reduction of prostaglandins, the gastric mucosal barrier function is weakened, which easily leads to gastric mucosal congestion, edema, erosion, ulcers, and bleeding.

Aspirin, whether it is an ordinary tablet or an enteric-coated tablet, whether taken before or after a meal, as long as it is aspirin will damage the gastric mucosa, especially those with gastric disease and elderly patients will be more serious and more likely to have gastrointestinal bleeding.

Gastric mucosal damage will occur after 3 or 4 days of taking aspirin. Gastric mucosal damage reaches its peak at 3 months after taking aspirin. It is the most common stage of gastrointestinal damage within 12 months. After 12 months, the incidence of gastrointestinal damage will decrease. But it will still be significantly higher than the general population.

Even a small dose of aspirin (75mg/day) can still cause damage to the gastric mucosa, especially in high-risk groups of gastrointestinal bleeding.

High-risk groups of gastrointestinal bleeding caused by aspirin:

■Age ≥65 years old, especially elderly patients over 70 years old;

■Have a history of peptic ulcer (gastric ulcer, duodenal ulcer) or original bleeding;

■Combined with Helicobacter pylori infection;

■Combined antiplatelet therapy (such as clopidogrel);

■Combined anticoagulant therapy (such as warfarin);

■Combined use of other non-steroidal anti-inflammatory drugs;

■Combined treatment with glucocorticoid drugs.

Some patients may ask: Since aspirin has damage to the stomach, can switching to clopidogrel reduce the damage to the stomach?

The Answer Is Negative!

Clopidogrel is an adenosine diphosphate (ADP) receptor antagonist, which can selectively block the ADP receptor on the platelet membrane, thereby antagonizing platelet aggregation. Therefore, clopidogrel and aspirin have the same effect of inhibiting platelet aggregation, and it is a commonly used drug to prevent cardiovascular and cerebrovascular atherosclerotic diseases.

Although clopidogrel does not directly damage the gastrointestinal mucosa, it can inhibit platelet-derived growth factor and vascular endothelial growth factor released by platelets, thereby blocking the formation of new blood vessels, affecting the self-repair function of gastric mucosa, and weakening the protection of gastric mucosa barrier. Erosion and ulcers can occur under the action of gastric acid, pepsin, bile, drugs, alcohol, Helicobacter pylori and other damaging factors. Clopidogrel can aggravate existing gastrointestinal damage, affect the healing of erosions and ulcers, and even lead to Its bleeding and perforation.

Studies have compared the side effects of aspirin and clopidogrel. Compared with 325mg/d aspirin and 75mgd clopidogrel, there was no difference in the incidence of total adverse reactions and no difference in bleeding complications. Compared with the aspirin group (325 mg/d), the 883 patients who took clopidogrel for one year reduced gastrointestinal bleeding by only one case. Severe rash and diarrhea were more common in the clopidogrel group.

Therefore, clopidogrel induces gastrointestinal bleeding not less than aspirin. At present, for patients with gastrointestinal damage caused by aspirin, it is not recommended to switch to clopidogrel, but to use aspirin with proton pump inhibitors to prevent gastrointestinal bleeding.

How To Prevent Gastrointestinal Damage For Patients Who Need To Take Aspirin For A Long Time?

Before taking the medicine, the patient needs to see a gastroenterologist for a gastroscopy and Helicobacter pylori examination to understand your current gastric disease and treat it in advance if necessary.

1. Helicobacter Pylori Test

Helicobacter pylori, gastric acid, and aspirin are all important gastric mucosal damage factors. The superposition of the two will aggravate gastric mucosal damage and more easily lead to peptic ulcer and bleeding.

In the 2017 "Fifth National Consensus on the Treatment of Helicobacter Pylori Infection", it was clearly stated that Helicobacter pylori must be eradicated before planning to take long-term non-steroidal anti-inflammatory drugs (including low-dose aspirin).

There are many methods to check Helicobacter pylori. The C13 or C14 breath test is recommended for simple bacteria detection, which is safe, convenient, fast, and highly accurate.

If Helicobacter pylori is positive, it must be eradicated first. At present, quadruple therapy is advocated, namely: double-dose proton pump inhibitor (PPI) + two antibiotics + bismuth, treatment course of 10 to 14 days.

The drug was stopped for one month after treatment, and the C13 or C14 breath test was reviewed to ensure that Helicobacter pylori was eradicated.

2. Gastroscopy

The purpose of gastroscopy is to understand the patient's current gastric disease, whether there is gastroduodenal erosion or ulcer, to assess the risk level of gastrointestinal bleeding in patients using aspirin.

1. If the gastroscopy shows that the patient has gastroduodenal erosion or ulcer, they must be treated with drugs first, and PPI is commonly used (such as omeprazole, pantorazole, rabeprazole, esomeprazole, etc.) Combine gastric mucosal protective agents (such as aluminum allantoin, rebamipide, teprenone, mizolin granules, etc.) for 2 to 3 months. If the ulcer is obvious, the gastroscope needs to be reviewed after taking the medicine to ensure that the ulcer is healing with a white scar.

Take aspirin after the stomach disease is cured.

2. For patients with chronic ulcers, especially those with a history of bleeding in the past, even if the ulcers have healed after gastroscopy, it is best to take PPI for a long time while taking aspirin for high-risk patients with gastrointestinal bleeding to prevent ulcers. Recurrence and rebleeding.

3. Patients who are diagnosed as superficial gastritis or atrophic gastritis by gastroscopy can take aspirin directly.

4. Gastroesophageal reflux disease is relatively common in clinical practice, including esophagitis, gastroesophageal reflux disease with negative gastroscopy, which often manifests as acid reflux and heartburn. Many patients mistake it for stomach disease. In fact, the main reason for such patients It is the transient relaxation of the lower esophageal sphincter, gastroesophageal reflux disease and increased visceral sensitivity, which are different from gastroduodenal erosions and ulcers. Such patients can take aspirin and follow the doctor's advice.

3. Elderly Patients

For elderly patients 70 years and older, because the gastric mucosal barrier function is significantly degraded, it is recommended to take aspirin and a standard dose of PPI every day to prevent bleeding.

So, How Safe Is It To Take PPI For A Long Time?

According to research, long-term use of PPI, continuous and daily use for more than 1 year, will increase the risk of gastric cancer! Side effects such as nausea, vomiting, abdominal distension, constipation, and kidney damage may also occur.

For patients who need to use PPI for a long time, Doctors suggest:

(1) Helicobacter pylori must be eradicated first.

(2) Try to use the smallest dose of PPI for maintenance treatment.

(3) PPI and H2 receptor blockers (such as ranitidine, famotidine, etc.) are used alternately, which can reduce the side effects of long-term use of the two, and can avoid the resistance of H2 receptor blockers.

In short, if the patient has a clear indication that he must take aspirin, he must first seek medical advice from a gastroenterologist. The gastroenterologist will recommend that you undergo gastroscopy, Helicobacter pylori and other examinations to understand your current gastric condition, combined with your age and taking Drugs to assess whether you are a high-risk patient with gastrointestinal bleeding. Suggest:

If you have a gastric disease, it is recommended to take aspirin after cure;

If Helicobacter pylori is positive, it must be eradicated first;

For elderly patients over 70 years old, in addition to eradicating Helicobacter pylori, it is recommended to take a standard dose of PPI prophylactically;

For chronic ulcers, especially patients with a history of bleeding in the past, it is recommended to use PPI for a long time;

For patients with peptic ulcer and bleeding after taking aspirin, switching to clopidogrel will not reduce gastrointestinal complications, and it is recommended that aspirin be combined with PPI;

In order to reduce the side effects of long-term use of PPI, PPI and H2 receptor blockers can be used interchangeably.

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