Comparative Gastrointestinal Bleeding Risks of the P2Y12 Inhibitors

Third-generation P2Y₁₂ inhibitors are associated with an increased risk for GI bleeding compared with clopidogrel.

The P2Y₁₂ inhibitors (formerly thienopyridines) are a class of antiplatelet agents associated with gastrointestinal (GI) bleeding, especially in combination with aspirin (dual antiplatelet therapy). However, it is not clear if the more-potent, third-generation P2Y₁₂ inhibitors (prasugrel and ticagrelor) are associated with an increased risk for GI bleeding.

In a meta-analysis of data from almost 60,000 patients across 12 randomized, controlled trials, third-generation P2Y₁₂ inhibitors were associated with a higher risk for GI bleeding (relative risk, 1.3) compared with clopidogrel, a second-generation P2Y₁₂ inhibitor. The risk elevation was for upper GI bleeding and unspecified GI bleeding but not lower GI bleeding. In a subgroup analysis, p…

Reviewing Author

John R. Saltzman, MD

Disclosures

Consultant/Advisory BoardIterative Scopes

Editorial BoardsGastrointestinal Endoscopy; UpToDate

Leadership Positions in Professional SocietiesAmerican College of Gastroenterology (Trustee)

OtherVice President of Medical Affairs, 1Globe Health Institute