The Impact of Long-Term Antiplatelet Therapy on the Upper Gastro-Intestinal Tract to Elderly Patients

Introduction In recent years there has been an increased incidence of cardiovascular diseases and therefore an increased number of patients with antiplatelet therapy, which led to bleeding complications. Aim. Evaluation of potential hemorrhagic lesions of the upper digestive tract in patients receiving long-term antiplatelet treatment (over 6 months). Materials and Methods We performed a retrospective descriptive study which included all patients with upper gastrointestinal bleeding (hematemesis or melena) who were admitted to the Emergency County Hospital "St. Spiridon" Gastroenterology and Hepatology Center Iasi and were receiving chronic antiplatelet treatment during the period of 1 January to 31 December 2018. Results From a total of 850 cases of upper gastrointestinal bleeding (upper gastrointestinal hemorrhage), 45 cases (5.29%) were receiving antiplatelet treatment. The average age was 71 years, with male predominance (59%) and a ratio of 1.3. The diseases for which they received antiplatelet therapy were: 72% cardiovascular diseases and 18% strokes. 38 (4.47%) were smokes and chronic alcohol consumption was encountered in 29 (3.41%) patients. 26 (57.7%) of patients received intermittent treatment with NSAI and 37 (82.2%) patients had associated antiplatelet therapy with a proton pump inhibitor (PPI). Upper gastrointestinal hemorrhage type Forrest II was detected in 78% of patients. The main endoscopic lesions found in patients receiving antiplatelet therapy were the duodenal bulbar ulcers in 23 cases (51.1%), followed by acute hemorrhagic gastritis in 8 cases (17.7%), angiodysplasia in 2 cases (4.44%), gastric cancer in 4 cases (8.88%), Mallory-Weiss syndrome in 5 patients (11.1%) and esophageal ulcer in 3 patients (6.66%). Conclusions Despite the widespread use of antiplatelet therapy and its beneficial effects for elderly patients, the long-term use is encumbered by digestive complications requiring gastroenterological supervision and association of proton pump inhibitors during treatment.