Management of patients with high gastrointestinal risk on antiplatelet therapy.
Increasing use of antiplatelet therapies is associated with increasing GI complications, such as ulceration and GI bleeding. Identification of high-risk patients and, in such patients, incorporation of strategies to reduce their GI risk would be clinically prudent. After assessment and treatment of H pylori in patients with prior ulcer or GI bleeding histories, further reduction in GI risk in other high-risk patients who require antiplatelet agents is primarily accomplished by prescribing drugs that when coadministered with antiplatelet agents protect against mucosal ulceration, primarily proton pump inhibitors (PPIs). However, observational studies indicate a higher cardiovascular event rate in patients taking PPIs along with clopidogrel and aspirin compared with that of patients undergoing dual antiplatelet therapy without PPIs. Whether concurrent use of a PPI with clopidogrel represents a safety concern or not is currently being evaluated by the US Food and Drug Administration. Until more specific regulatory guidance is available, current recommendations are that patients taking both PPIs and clopidogrel concurrently should probably continue to do so until more data become available.
Cryer
Byron
B
Department of Veterans Affairs Medical Center, Medical Service, Digestive Diseases, North Texas VA Medical Center, 4500 S Lancaster Road, Dallas, TX 75216, USA. byron.cryer@utsouthwestern.edu
D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use; D000077144:Clopidogrel; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D006801:Humans; D010437:Peptic Ulcer / Q000150:complications; D010438:Peptic Ulcer Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000068799:Prasugrel Hydrochloride; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine; D001241:Aspirin