Effect of Dual Antiplatelet Therapy on Gastric Mucosa in Stroke Patients (Endoscopic Evaluation)

Introduction: Our study was conducted prospectively on twenty patients with acute non-hemorrhagic cerebrovascular stroke in the period from December 2007 to December 2008 aiming at evaluating and comparing gastric complications of dual antiplatelet therapy Vs Monoantiplatelet therapy using upper GI endoscopy. Methods: Patients were divided into 2 equal groups (Group A, maintained on Aspocid 150mg group B maintained on Aspocid 150mg plus Clopidogrel 75mg). Both groups were maintained on antiplatelets for 1 week and evaluated endo-scopically twice, according to Rypins grading of gastric mucosa, once upon admission and another follow-up after a week of initiating antiplatelet therapy to detect gastric complications. Results: There was no significant difference as regard age of both groups (p-value 0.496). Sex had non significant difference (p-value 0.65). There was a non significant difference between the two groups regarding diabetes mellitus, hypertension, smoking, previous CVA and dyslipidemia. A non significant difference between both groups regarding neuro-logical findings (p-value 0.82). Regarding Glasgow Coma Scale (GCS), there was non significant difference between the two groups (p-value 0.125). A non significant difference between the two groups regarding presence of gastric symptoms (p-value 0.582). As regards previous usage of antiplatelets, there was a significant difference between the two groups (p-value 0.007). In group A, Ninety percent of patients had the same endoscopic findings (grading 0-3) at day 0 and day 7 and only 10% of patients deteriorated, regarding endoscopic findings, from grade 0 to grade 7. In group B, Forty percent of patients had the same endoscopic gastric findings (grading 0-4) and 60% deteriorated-10% of them progressed from grade 1 to 7,10% progressed from grade 2 to 7,20% progressed from grade 3 to 7,10% progressed from grade 0 to 3 and 10% progressed from grade 3 to 6. There was statistically significant difference in both groups with a p-value 0.0198 that indicated that gastric complication increased markedly with usage of dual antiplatelets drugs in relation to Monoantiplatelet drugs. A non significant difference between the two groups regarding the outcome (mortality) (p-value 1.0). Conclusion: The combination of dual antiplatelet therapy (Aspirin clopidogrel) increased gastric complications in comparison to Monoantiplatelet therapy (Aspirin) alone and so it is not recommended.