Efficacy of rabeprazole in treating ulcers was high with either aspirin or clopidogrel.

Aspirin and clopidogrel are antiplatelet drugs used to prevent thrombotic vascular events. However, both are associated with increased risk for bleeding from peptic ulcer disease (PUD). Aspirin induces peptic ulcers, and both drugs prevent their healing — aspirin through inhibiting mucosal prostaglandin generation and clopidogrel by decreasing platelet-related growth factors. Proton-pump inhibitor (PPI) treatment is effective for healing aspirin-associated PUD, but for patients requiring continued antiplatelet therapy, it is unclear whether the outcomes are different in patients taking clopidogrel versus aspirin.


To investigate this issue, researchers randomized 218 patients with aspirin-related, nonbleeding, symptomatic PUD to receive rabeprazole (20 mg/day) with either clopidogrel (75 mg/day) or aspirin (100 mg/day) for 12 weeks. Endoscopy was used to both determine PUD diagnosis and evaluate the primary outcome of ulcer healing.

The healing rate was similar in both groups after 12 weeks (90% for clopidogrel and 86% for aspirin). In multivariate regression analyses, independent risk factors for treatment failure were ulcer size >10 mm (odds ratio, 6.3) and a history of PUD (OR, 3.7). One patient in each group had a major adverse cardiovascular event. No patient developed PUD-related bleeding.


Citation(s):

Luo J-C et al. Randomised clinical trial: Rabeprazole plus aspirin is not inferior to rabeprazole plus clopidogrel for the healing of aspirin-related peptic ulcer. Aliment Pharmacol Ther 2011 Sep; 34:519.