The effect of alternating use of enteric-coated aspirin and clopidogrel on gastrointestinal symptoms and patient compliance in elderly patients with coronary heart disease

Abstract: Background: Dual antiplatelet therapy (DAPT) is essential for secondary prevention of coronary artery disease (CAD), but gastrointestinal (GI) intolerance often leads elderly patients to self-reduce the dose or discontinue medication. Objectives: To compare the effects of monthly alternating aspirin and clopidogrel versus continuous DAPT on GI symptoms, medication adherence and 6‑month major adverse cardiovascular events (MACE) in elderly community patients with stable CAD. Methods: This retrospective cohort study included 160 elderly patients with stable CAD, who were non-randomly assigned to alternating DAPT (n=80) or continuous DAPT (n=80) according to their documented antiplatelet regimens in clinical practice. GSRS, MMAS-8 and adverse events were evaluated at baseline and 6 months. Results: At 6 months, the observation group’s GSRS total score remained stable (15.14±4.52 to 15.84±4.89, +0.70, P>0.05), while the control group significantly worsened (15.18±4.48 to 19.59±5.67, +4.41, P<0.05); the between-group difference was significant (P<0.05). The MMAS-8 score was higher in the observation group (7.58±0.76 vs. 6.94±1.15, P<0.001), with higher adherence rates (72.50% vs. 51.25%, P=0.006). Total GI adverse events were lower in the observation group (6.25% vs. 18.75%, P=0.017), but GI bleeding did not differ significantly. MACE occurred in 3 cases (3.75%) in each group (P=1.000); however, statistical power was severely insufficient to infer cardiovascular non‑inferiority. Conclusion: Alternating monthly use of aspirin and clopidogrel during the 6-month observation period of this study did not show a significant increase in the risk of MACE. Under these conditions, this regimen attenuated the progressive worsening of gastrointestinal symptoms in elderly patients (scores remained stable rather than significantly worsening) and significantly improved medication adherence. Within this study's specific population (stable elderly CAD patients) and 6-month observation window, this strategy offers a promising alternative worthy of further investigation. Its long-term benefits and cardiovascular safety require confirmation by prospective large-scale trials.