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Abstract The traditional definition of stroke, devised by the World Health Organization in the 1970s, (World Health Organization) is a ”neurological deficit of cerebro-vascular cause that persists beyond 24 hours or is interrupted by death within 24 hours”. It is the third leading cause of death in the United States. It is the leading cause of adult disability in the United States and Europe. It is the 2nd cause of death world-wide and may soon become the leading cause of death worldwide (Feigin VL, 2005). Currently, antiplatelet agents are recommended for the prevention of recurrent ischemic vascular events (CAPRIE Steering Committee.1996). Although these agents are primarily used as monotherapy, recent data suggest that outcomes can be improved with dual antiplatelet therapy. The suppression of gastro-duodenal mucosal prostaglandin synthesis is one of the important mechanisms of mucosal damage by acetyl salicylic acid (Weil J, et al.1995). Serious GI ulcer complications are 2- to 4-fold more common in patients who take 75 to 300 mg/d of aspirin compared with controls. During a 4-year period in the United Kingdom Transient Ischemic Attack study, GI complications in patients taking aspirin ranged from mild dyspepsia (31%) to life-threatening bleeding and GI erosions or ulcerations and perforation (8%) (Farrell B, et al.1991). Few human studies document Clopidogrel’s potential for independent injury to the GI mucosa. A single endoscopic study with limited follow-up failed to demonstrate mucosal injury in humans (Fork FT, Lafolie P, Toth E, Lindgarde F. 2000). It remains unclear whether clopidogrel exerts an independent injurious effect on the GI mucosa, or whether it merely induces bleeding in already damaged mucosa via its antiplatelet effects. Our study included twenty patients who were admitted to our department in the period from December 2007 to December 2008 , with acute non-hemorrhagic cerebro-vascular stroke. Patients were divided into two equal groups; The 1st group was maintained on Monoantiplatelet therapy (Aspirin 150mg) and the 2nd group was maintained on Dual-antiplatelet therapy (Aspirin 150 mg + Clopidogrel 75 mg) for one week. Our aim in this study was to Evaluate & compare short term gastrointestinal complications of dual antiplatelet therapy (Aspirin, Clopidogrel) versus mono antiplatelet therapy (Aspirin) in recent cerebrovascular accidents. All patients were evaluated on admission by: Full clinical assessment including history & general examination. Full neurologic examination, Glasgow Coma Score (GCS) and CT brain (to exclude cerebral hemorrhage). Laboratory Assessment: Complete blood count (CBC), Renal function tests (Urea, Creatinine). Random blood sugar (RBS), Coagulation profile (PC, INR, PTT, and PT). Liver function tests (SGPT, SGOT, T.Bil, D.Bil, Total protein and Serum albumin) and Cholesterol Level. Abdominal ultrasound. Upper GIT endoscopy. All patients were subjected to upper GI endoscopy at the day of admission and seven days later. The mean age of the studied population was 66 ± 10.193 years (nine patients were males and eleven were females). The age of all patients in the study ranged from 39 to 85 years. There was no statistically significant difference as regards age of both groups with a P value 0.496. Concerning our results; There was no statistically significant difference between CVA risk factors; Diabetes mellitus (P value 1.0), Hypertension (P value 1.0), Dyslipidemia (P value 1.0), Previous CVA (P value 0.58) and smoking (P value 1.0), and developing of gastric complications. Regarding upper gastrointestinal manifestations patients were divided according to selected gastric symptoms into symptomatic (epigastric pain, Haematemsis) and asymptomatic, there was no statistically significant difference between both groups (P value 0.582). Our results showed that the only independent risk factor that had a statistically significant difference as regards developing gastric complications was the previous usage of antiplatelet therapy (P value 0.007). Our results revealed that there was increase of gastric complications with deterioration of endoscopic gastric findings according to the endoscopic classification suggested by Rypins et al in group B who received dual antiplatelet therapy for one week compared to in group A who received Monoantiplatelet therapy for the same period. In group A, 90% 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, whereas, in group B, 40% 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 with a statistically significant difference between both groups (P value 0.0198). Our results revealed no statistically significant difference as regards mortality (P value 1.0). |