Experts OK Antiplatelets and PPIs for Heart Patients With GI Bleeding Risks

Abstract

AFTER 2 YEARS OF CONFUSION AND anxiety from conflicting research results, physicians have new guidance in determining which patients with cardiovascular disease who take antiplatelet therapy will reap the most benefit from also taking a proton pump inhibitor (PPI) to reduce the risk of gastrointestinal (GI) bleeding. In mid-November, the American College of Cardiology Foundation, the American College of Gastroenterology, and the American Heart Association released a consensus document that gives a green light to the concomitant use of antiplatelet drugs and PPIs in patients who are at high risk for upper GI bleeding (http://tinyurl.com /289g85d). “The key messages we want to get through to physicians and patients is that physicians should not prescribe [PPIs] routinely, but they should weigh the individual risks and benefits for each patient,” said Neena Abraham, MD, chair of the writing committee that produced the document and a gastroenterologist at the Michael E. DeBakey VA Medical Center in Houston. “Our consensus group really tried to . . . highlight the group in which the proton pump inhibitors would have the most bang for the buck,” she added. The document recommends concomitant antiplatelet and PPI medications for patients with a history of prior upper GI bleeding, which is the strongest risk factor linked with GI bleeding while taking antiplatelet agents. Additional factors that increase the risk of GI bleeding with antiplatelets are advanced age; current use of anticoagulants, steroids, or nonsteroidal anti-inflammatory drugs including aspirin; and infection with Helicobacter pylori, which is known to increase the risk of ulcers. The use of PPIs is appropriate in patients who take antiplatelet drugs and have multiple risk factors, according to the document.