Single Antiplatelet Therapy for Patients with Previous Gastrointestinal Bleeds

Objective:To determine whether aspirin plus a proton pump inhibitor (PPI) is preferable, from a gastrointestinal bleed (GIB) risk perspective, to clopidogrel in patients who have experienced a GIB while on aspirin and who require single antiplatelet therapy for secondary prevention of cardiovascular disease.Data Sources:A literature search was conducted using EMBASE (1980–January 2008), PubMed (1966–January 2008), Google, and a manual search of the reference lists using the search terms gastrointestinal bleed, gastrointestinal hemorrhage, peptic ulcer hemorrhage, ASA, aspirin. Plavix, clopidogrel, and PPI. The search, limited to human and English studies, yielded 110 returns.Study Selection and Data Extraction:Randomized trials that compared aspirin with clopidogrel, involved patients who had previously experienced a GIB, and provided detailed information on the type and dose of drugs used were included. Studies were required to provide information on the recurrence of GIB.Data Synthesis:Two randomized tr...