The primary endpoint was a composite of upper gastrointestinal bleed or recurrent ulcer
In a randomized trial of patients who had had previous NSAID-induced ulcer bleeding, the COX 2 inhibitor celecoxib was shown to be as effective as a combination of the NSAID diclofenac and the PPI omeprazole for prevention of recurrent ulcer
These results "confirm our hypothesis that esomeprazole can effectively prevent recurrent ulcer
in clopidogrel users who have a peptic ulcer history," the investigators said.
A double-blind randomised controlled trial (5) which enrolled patients at high risk for recurrent ulcer
bleeding showed that a combination of a high-dose PPI (esomeprazole 20 mg twice daily) and celecoxib (200 mg twice daily) was significantly better than celecoxib alone in preventing GI complications.
Clopidogrel should not be substituted for aspirin in patients who have previous ulcer bleeding in an effort to reduce the risk of recurrent ulcer
1,2) This opinion was validated by the results of a recent RCT that found that treatment with esomeprazole plus celecoxib was significantly superior to celecoxib alone for the prevention of recurrent ulcer
bleeding (FIGURE 1).
Clopidogrel should not be substituted for aspirin as a strategy to reduce recurrent ulcer
bleeding in high-risk patients, because it is inferior to the combination of aspirin plus PPIs.
Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer
The 13-month cumulative incidence of recurrent ulcer
bleeding in this trial was 0% in subjects randomized to the combination therapy, compared with 8.
The primary outcome was recurrent ulcer
bleeding within 6 months.