| Abstract: | OBJECTIVES: To compare the risk of recurrent peptic ulcer in patients who have experienced gastrointestinal bleeding and who require ongoing anti-platelet therapy (aspirin or clopidogrel) whether using proton-pump inhibitor (PPI) in combination. METHODS: In this population-based, retrospective cohort study, we used Taiwan’s 2000–2006 National Health Insurance Database to explore the risk of hospitalizationfor peptic ulcer associated with anti-platelet therapy used alone or in combination with PPI by patients previously diagnosed with peptic ulcers. In total, 14,627 patients (aspirin [12,001] and clopidogrel [2,626]) who had history of peptic ulcer beforehe or she began using antiplatelet agent were selected. Recurrence of peptic ulcer were analyzed using Cox proportional hazards model, with adjustment for age, gender, medical history, using of non-steroidal anti-infl ammatory drugs, and other medications. Propensity score method was used in adjustment for self selection bias. RESULTS: The incidences of recurring peptic ulcer per person years were0.125 for Aspirin without PPI, 0.102 for Aspirin with PPI, 0.128 for Clopidogrelwithout PPI, and 0.152 for Clopidogrel with PPI. Patients taking clopidogrel were at signifi cantly lower risk of hospitalization for peptic ulcer (HR 0.85 [95% CI: 0.76–0.95]) than those taking aspirin. Concomitant use of PPI signifi cantly lowered that risk for aspirin users (0.76 [0.64–0.91]), but did not appear to offer the same protection to clopidogrel users (1.08 [0.89–1.33]). An adjusted survival curve of risk of recurring peptic ulcer showed that the risk increased signifi cantly faster in clopido-grel users than patients using aspirin and PPI, though their average drug cost per person year was NT $12,500.08 o 15,134.46, which was much higher than NT$3,712.39 o 14,608.05 spent by Aspirin-PPI users. CONCLUSIONS: Aspirin plus aPPI could be considered more cost-effective to clopidogrel in reducing risk of pepticulcer, when used for the secondary prevention of cardiovascular events in high gas-trointestinal risk group. |
