title: [Antiplatelet agents and proton pump inhibitors. How can the risk-benefit balance be optimized in patients at risk for cardiovascular disease and gastrointestinal bleeding?].
abstract: Antiplatelet agents are routinely used in both primary and secondary prevention of cardiovascular events. The development of new antiplatelet agents and the strong growth of interventional cardiology have led to this therapy being more widely prescribed and for longer periods. The most important secondary effect is the rise in the incidence of hemorrhagic complications, the most prevalent being gastrointestinal bleeding. In this context, the balance between the cardiovascular benefits and bleeding risk of these agents must be optimized. This review provides specific management recommendations and highlights important practical aspects related to antiplatelet therapy, including the interaction between clopidogrel and proton pump inhibitors. The benefits and hazards in distinct clinical settings are outlined within the context of optimizing the balance between the cardiovascular benefits and bleeding risk of antiplatelet therapy.
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España. casadorbn@yahoo.es
authors.forename: Rubén
authors.initials: R
authors.lastname: Casado-Arroyo
authors.forename: María
authors.initials: M
authors.lastname: Muñoz-Villalenguas
authors.forename: Angel
authors.initials: A
authors.lastname: Lanas Arbeloa
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D000077144:Clopidogrel; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004347:Drug Interactions; D004351:Drug Resistance; D005260:Female; D005544:Forecasting; D005756:Gastritis / Q000150:complications / Q000188:drug therapy; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D018570:Risk Assessment; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin