Background: Antiplatelet therapy is the cornerstone in the treatment of cardiovascular disease and atherosclerosis. Based on the role of platelets in inflammation and coagulation it has been suggested that antiplatelet treatment could be beneficial for patients with inflammatory bowel disease (IBD). Data on the prevalence of antiplatelet use as well as on safety and long-term effect of these agents in patients with Ulcerative Colitis (UC) and Crohn Disease (CD) are limited. The aim of this study was to investigate the prevalence and the long term effect of antiplatelet use in IBD.
Methods: Records of 594 consecutive IBD patients that are regularly followed at the University Hospital of Heraklion were reviewed and patients on antiplatelet treatment were identified. Each one IBD patient on antiplatelet treatment was matched for age, sex, disease duration and extent with one IBD patient without any antiplatelet use. Side effects of antiplatelet therapy, as well as hospitalizations, emergency department (ED) visits, medications use, endoscopic findings and disease activity scores were analyzed.
Results: Forty patients (6.7%), 32 male, 18 CD- 22 UC, mean age 63.8±11.8 years, with mean follow up period 121.8±109.2 days receiving long term antiplatelet therapy (46.1% low dose aspirin, 35.9% clopidogrel, 10.2% on combination, 7.8% other antiplatelet agent) were identified. No difference was found between IBD patients on regular antiplatelet treatment comparing to those not receiving, regarding corticosteroid use (lifetime 62.5% vs 55%, p=0.518 or since the beginning of antiplatelet therapy 45% vs 25%, p=0.171), budesonide (35% vs 27.5%, p=0.243), biologic agents (27.5% vs 12.5%, p=0.161) or immunomodulators (52.4% vs 30%, p=0.378). IBD related ED visit frequency was not associated with antiplatelet use (65% vs 45%, p=0.178). IBD patients on antiplatelet treatment had more frequent and higher number of hospitalizations (85% vs 37.5%, p<0.001), more often clinically active disease during follow up (32.5% vs 20%, p=0.027), but there was no difference in endoscopic activity (35% vs 32.5%, p=0.899). No significant differences between UC and CD were found.
Conclusions: The prevalence of antiplatelet use in Greek patients with IBD is 6.7%. No beneficial effect of antiplatelet treatment in patients with IBD was observed. Long term antiplatelet use was found to be relatively safe in IBD patients but further larger prospective studies are needed.