Azita H Talasaz, Parham Sadeghipour, Luis Ortega-Paz, Hessam Kakavand, Maryam Aghakouchakzadeh, Craig Beavers, John Fanikos, John W Eikelboom, Deborah M Siegal, Manuel Monreal, David Jimenez, Muthiah Vaduganathan, Lana A Castellucci, Adam Cuker, Geoffrey D Barnes, Jean M Connors, Eric A Secemsky, Benjamin W Van Tassell, Raffaele De Caterina, Jacob E Kurlander, Ali Aminian, Gregory Piazza, Samuel Z Goldhaber, Lisa Moores, Saskia Middeldorp, Ajay J Kirtane, Mitchell S V Elkind, Dominick J Angiolillo, Stavros Konstantinides, Gregory Y H Lip, Gregg W Stone, Mary Cushman, Harlan M Krumholz, Roxana Mehran, Deepak L Bhatt, Behnood Bikdeli
Balancing the safety and efficacy of antithrombotic agents in patients with gastrointestinal disorders is challenging because of the potential for interference with the absorption of antithrombotic drugs and for an increased risk of bleeding. In this Review, we address considerations for enteral antithrombotic therapy in patients with cardiovascular disease and gastrointestinal comorbidities. For those with gastrointestinal bleeding (GIB), we summarize a general scheme for risk stratification and clinical evidence on risk reduction approaches, such as limiting the use of concomitant medications that increase the risk of GIB and the potential utility of gastrointestinal protection strategies (such as proton pump inhibitors or histamine type 2 receptor antagonists)...
March 20, 2024: Nature Reviews. Cardiology