Magnetically controlled capsule endoscopy detects GI injury from antiplatelet therapy
Click Here to Manage Email Alerts
Magnetically controlled capsule endoscopy identified gastrointestinal injury in a majority patients taking antiplatelet therapies following PCI and may represent a noninvasive alternative to standard upper GI endoscopy, a speaker reported.
According to findings from the OPT-PEACE trial presented at TCT 2021, GI injury detected using capsule endoscopy was more common in patients on dual antiplatelet therapy than those on single antiplatelet therapy.
The results were simultaneously published in the Journal of the American College of Cardiology.
“We know that gastrointestinal bleeding is the most frequent major complication of antiplatelet therapy. However, little is known about the rates and the types of gastrointestinal injury after antiplatelet therapy, mainly due to the very limited use of standard endoscopy in this patient cohort,” Yi Li, MD, of the General Hospital of Northern Theater Command in Shenyang, China, said during a press conference. “This trail provided detailed information about gastrointestinal mucosa injury in patients receiving different antiplatelet regimens and will inform future research directions of gastroprophylaxis in patients on antiplatelet treatment.”
For the double-blind, placebo controlled randomized trial, researchers analyzed patients at low bleeding risk who underwent magnetically controlled capsule endoscopy at baseline, prior to initiating a 6-month DAPT regimen. At 6 months, researchers performed another capsule endoscopy, and randomly assigned 505 patients to a single antiplatelet regime of aspirin plus placebo or clopidogrel plus placebo or a DAPT regime of aspirin plus clopidogrel. A final capsule endoscopy was performed at 12 months from baseline. The primary endpoint was gastric or small intestinal mucosal injury, such as erosion, ulceration or bleeding, at 6 or 12 months.
Researchers observed fewer occurrences of gastrointestinal injury among patients on single antiplatelet therapy compared with DAPT (94.3% vs. 99.2%; P = .02); however, the between group differences in erosion (single therapy, 93.6%; DAPT, 96.9%; P = .16) and ulceration (P = .3) were not significant.
Among patients who had not experienced any gastrointestinal injury by 6 months, the 12-month occurrence of gastrointestinal injury (68.1% vs. 95.2%; P = .01) and ulceration (8.5% vs. 38.1%; P = .006) was lower in patients on single antiplatelet therapy compared with DAPT. The between-group difference for the outcome of erosion remained nonsignificant (single therapy, 63.8%; DAPT, 81%; P = .16).
Researchers also observed less gastrointestinal bleeding among patients taking single antiplatelet therapy compared with DAPT (0.6% vs. 5.4%; P = .001).
“The use of a novel magnetically controlled capsule endoscopy system showed that nearly all low-bleeding-risk patients developed gastrointestinal injury during 12-month follow-up after PCI regardless of antiplatelet regimen,” Yaling Han, MD, of the General Hospital of Northern Theater Command in Shenyang, China, said in a press release. “However, DAPT followed by SAPT resulted in less gastrointestinal mucosal injury and clinical bleeding. These findings are valuable for clinical decision-making on gastroprophylaxis and optimizing antiplatelet therapy type and duration.”
Reference:
Collapse
Han Y, et al. Late-Breaking Clinical Trials Session III, in Collaboration with JACC. Presented at: TCT Scientific Symposium; Nov. 4-6, 2021; Orlando (hybrid meeting).
Click Here to Manage Email Alerts