الفهرس 
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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).