Outcomes of Antiplatelet Therapy Continuation in Older Hypertensive Adults With Peptic Ulcer Disease

BackgroundThe appropriateness of continuation of antiplatelet therapy in older hypertensive aspirin users with documented peptic ulcer disease (PUD) is uncertain. MethodsThis multicenter cohort study screened adults aged 65 years or older, using aspirin for primary and secondary cardiovascular disease prevention between January 2014 and December 2018. Patients with panendoscopy-proven PUD and hypertension were identified. Subsequent antiplatelet strategies were categorized as aspirin discontinuation (AD), aspirin continuation (AC), and switch to clopidogrel (SC) groups. Inverse probability of treatment weighting was applied to balance baseline characteristics. The main outcomes were incident major adverse cardiac events (MACEs) and hospitalizations for upper gastrointestinal bleeding (UGIB), followed through 31 December 2020. Results735 eligible patients were analyzed. During a median follow-up of 39.7 months, 178 MACEs occurred. Compared with AD, SC was not related to the risk of incident MACEs, but AC increased the risk of incident MACEs (adjusted HR, 1.58; 95% CI, 1.04-2.38) in secondary prevention patients. On the other hand, 102 hospitalizations for UGIB occurred during a median follow-up of 43.4 months. Compared with AD, neither AC nor SC affected the risk of hospitalization for UGIB in secondary prevention patients. However, secondary prevention patients with chronic kidney disease were at increased risk of hospitalizations for UGIB (adjusted HR, 2.41; 95% CI, 1.30-4.47). ConclusionsAC may increase the risk of incident MACEs in older hypertensive adults with PUD previously taking aspirin for secondary cardiovascular disease prevention. The appropriateness of antiplatelet therapy continuation after PUD is diagnosed in older hypertensive adults warrants rigorous considerations.