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Efficacy of H2 receptor antagonists for prevention of upper gastrointestinal bleeding during dual-antiplatelet therapy

Takeo Yasu, Noriko Sato, Yosuke Kurokawa, Shigeru Saito and Masaru Shoji

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Volume 51 p. 854 - 860

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 51 – No. 11/2013 (854-860)

Efficacy of H2 receptor antagonists for prevention of upper gastrointestinal bleeding during dual-antiplatelet therapy

Takeo Yasu¹,²,³, Noriko Sato⁴, Yosuke Kurokawa², Shigeru Saito⁵ and Masaru Shoji³

¹Department of Pharmacy, Shonan Kamakura General Hospital, Kanagawa, ²Department of Pharmacy, The Research Hospital, The Institute of Medical Science, The University of Tokyo, ³Department of Pharmacodynamics, Meiji Pharmaceutical University, Tokyo, ⁴Department of Pharmacy, Hayama Heart Center, and ⁵Department of Cardiology and Catheterization Laboratory and Heart Center, Shonan Kamakura General Hospital, Kanagawa, Japan
Proton pump inhibitors (PPI) are frequently used to prevent upper gastrointestinal bleeding (UGIB) in patients receiving dual-antiplatelet therapy (DAPT) with aspirin and clopidogrel. However, the concomitant therapy of PPI and DAPT has been associated with a decreased effect of the antiplatelet drugs and an increased risk of major adverse cardiovascular events (MACE). It has been suggested that histamine H2 receptor antagonists (H2RA) can be used as alternatives to PPI to prevent UGIB during DAPT without an increase in the risk of MACE. We tested this hypothesis in a retrospective cohort study including patients without a prior history of upper gastrointestinal events. We examined the incidence of UGIB and MACE in 296 patients treated with H2RA (H2RA group) and 447 patients not treated with H2RA (control group) during DAPT with aspirin and clopidogrel after drug-eluting stent implantation. The patients treated with PPI were excluded. In the 1-year follow-up, UGIB occurred in 2 patients (0.7%) in the H2RA group and 12 (2.7%) in the control group. The incidence of UGIB was significantly different between the two groups (p = 0.049 in log-rank test). MACE occurred in 31 patients (10.5%) in the H2RA group and in 54 patients (12.1%) in the control group, and the incidence was not significantly different (p = 0.447 in logrank test). Thus, H2RA may be effective safe alternatives to PPI during DAPT in patients without a prior history of upper gastrointestinal events.Correspondence to:
Takeo Yasu, MSc
The Research Hospital
The Institute of Medical Science
The University of Tokyo
4-6-1, Shirokanedai, Minatoku, Tokyo 108-8639, Japan
Email: [email protected]

Case Report

Bizarre astrocytes with cytoplasmic/intranuclear inclusions in an individual with alternating hemiplegia, migraine, and brain swelling associated with a GGC repeat expansion in NOTCH2NLC

Kaoru Yagita, Kyoko Kanazawa, Terunori Sano, Kunio Toda, Yuji Nakayma, Risa Kagaya, Noriko Sato, Yuji Takahashi, and Masaki Takao

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42.00 $

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Volume 45 (2026) p. 17 - 25

Abstract

Clinical Neuropathology, Vol. 45 – No. 1/2026 (17-25)

Bizarre astrocytes with cytoplasmic/intranuclear inclusions in an individual with alternating hemiplegia, migraine, and brain swelling associated with a GGC repeat expansion in NOTCH2NLC

Kaoru Yagita¹, Kyoko Kanazawa², Terunori Sano¹#³, Kunio Toda⁴, Yuji Nakayma⁵, Risa Kagaya⁶, Noriko Sato⁶, Yuji Takahashi², and Masaki Takao¹,³

¹Neuripathology Division, Department of Laboratory Medicine, ²Department of Neurology, ³Department of Internal Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, ⁴Department of Neurology, Shin-Matsudo-Chuo-Sogo Hospital, Chiba, ⁵Department of Pathology, Keio University School of Medicine, and ⁶Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
The aberrant GGC repeat expansion in the 5′-untranslated region of the NOTCH2NLC gene causes neuronal intranuclear inclusion disease (NIID), a progressive neurodegenerative disorder. The clinical features of NIID are highly variable and include cognitive dysfunction, peripheral neuropathy, and episodic neurogenic symptoms. The pathogenesis of episodic symptoms in NIIDs remains unknown, and histopathological studies are limited. Here, we report an autopsy case of NIID in a 32-year-old Japanese female who developed severe episodic symptoms, including hemiplegic migraine, seizures, and impaired consciousness. Her major episodic symptoms appeared at the age of 16 years and were accompanied by alternating brain edema. She developed severe episodic symptoms with right brain edema at the age of 31. She became bedridden due to irreversible brain lesions and died 1 year later from a catheter-related bloodstream infection. Neuropathological analyses revealed numerous neuronal intranuclear inclusions and white matter lesions. In addition, bizarre astrocytes with eosinophilic cytoplasmic or intranuclear inclusions were observed. GFAP immunoreactivity in the bizarre astrocytes was diminished, AQP4 showed a disorganized distribution. The histological changes observed in this case suggest an association between non-neuronal cellular disturbances and episodic neurogenic symptoms in NIIDs.Correspondence to:
Masaki Takao, MD, PhD
Department of Laboratory Medicine
National Center Hospital
National Center of Neurology and Psychiatry
Tokyo, Japan
Email: [email protected]

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