title: Pharmacokinetic and clinical evaluation of esomeprazole and ASA for the prevention of gastroduodenal ulcers in cardiovascular patients.
abstract: BACKGROUND
  Low-dose aspirin (ASA, 75 - 325 mg/day) is widely used for the primary and secondary prevention of cardiovascular (CV) diseases. However, the value of primary prevention ASA is uncertain as the reduction in occlusive events needs to be weighed against the significant increase in major bleedings. Prevention with antisecretory drugs has been proposed to reduce the incidence of ASA-induced gastrointestinal (GI) bleedings, but non-adherence to gastro-protection is of concern, as it significantly increases the risk of upper GI adverse events. Beside patients and physicians education, one approach to overcome non-adherence is the development of fixed-dose combination.
  
  
  METHODS
  This review explores the results of clinical studies on the influence of the combination esomeprazole (ESA) and ASA on pharmacokinetic (PK) parameters, and the role for such combination in prevention of CV events in patients at risk of gastric ulcers.
  
  
  CONCLUSIONS
  Patients at risk of ASA-induced gastroduodenal ulcer might benefit from a fixed ASA and proton pump inhibitor (PPI) combination. PK and PD parameters suggest there is no significant interaction between these drugs. Nevertheless, attention must be paid on the appropriate use of such combination, that is, still balancing the risk:benefit ratio in a real-life setting, and any increase in the proportion of patients receiving ASA and PPI should be considered as a warning signal.
authors: Centre d'Investigations Cliniques plurithématique 803 (INSERM CIC-P 803), CHU de Dijon, Bâtiment du Pr Marion, Dijon Cedex, France. marc.bardou@u-bourgogne.fr
authors: Marc
authors: M
authors: Bardou
authors: Alan N
authors: AN
authors: Barkun
authors: Samia
authors: S
authors: Hamza
authors: Isabelle
authors: I
authors: Le Ray
authors: Françoise
authors: F
authors: Goirand
mesh_terms: D000897:Anti-Ulcer Agents / Q000493:pharmacokinetics*; D001241:Aspirin / Q000493:pharmacokinetics* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D004347:Drug Interactions; D064098:Esomeprazole / Q000493:pharmacokinetics* / Q000627:therapeutic use; D006801:Humans; D010437:Peptic Ulcer / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000493:pharmacokinetics*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000897:Anti-Ulcer Agents; D010975:Platelet Aggregation Inhibitors; D064098:Esomeprazole; D001241:Aspirin