Within the class of medications, there is no clear evidence that one agent works better than another. 2018 Oct;8(5):630-646. doi: 10.21037/cdt.2018.10.01.Gulizia MM, Colivicchi F, Abrignani MG, Ambrosetti M, Aspromonte N, Barile G, Caporale R, Casolo G, Chiuini E, Di Lenarda A, Faggiano P, Gabrielli D, Geraci G, La Manna AG, Maggioni AP, Marchese A, Massari FM, Mureddu GF, Musumeci G, Nardi F, Panno AV, Pedretti RFE, Piredda M, Pusineri E, Riccio C, Rossini R, di Uccio FS, Urbinati S, Varbella F, Zito GB, De Luca L; ESC Scientific Document Group; Faculty for approval of the Consensus Document.Eur Heart J Suppl. Apixaban may confer the lowest risk for upper gastrointestinal bleeding out of the oral anticoagulants — and bleeding risk can be further lowered with proton pump inhibitors (PPIs) — according to a retrospective study in JAMA.
All rights reserved. Buffered and enteric-coated aspirin appear to carry a similar risk of upper gastrointestinal bleeding as non-coated preparations.The opinions expressed in this article are not necessarily those of the Editors of the Oxford University Press is a department of the University of Oxford. This is particularly interesting, because a fixed combination of aspirin and a PPI (esomeprazole) has been developed and is currently under approval. The opinions expressed in this article are not necessarily those of the Editors of the Muthiah Vaduganathan, Deepak L. Bhatt, Aspirin and proton-pump inhibitors: interpreting the interplay, Aspirin has a well-established role in secondary prevention of cardiovascular disease, but increases gastrointestinal bleeding, especially when used in high-risk patients. Unfortunately, gastrointestinal bleeding in patients after acute coronary syndrome portends poor prognosis and is independently associated with increased risk for adverse cardiovascular events and mortality.Prior work had suggested that PPIs may attenuate gastric absorption of aspirin based on preclinical data. 2017;906:325-350. doi: 10.1007/5584_2016_124.Hsiao FY, Tsai YW, Huang WF, Wen YW, Chen PF, Chang PY, Kuo KN.Clin Ther. In recent years, it has been heavily discussed whether PPIs may reduce the cardiovascular protection by aspirin and, even more so, clopidogrel. Unable to load your delegates due to an error We assessed the association between PPI use and clinical outcomes for patients treated with percutaneous coronary intervention (PCI) and dual-antiplatelet therapy (DAPT) with clopidogrel plus aspirin. Patients who were eligible for the proton-pump inhibitor randomization were also randomly assigned in a 1:1 ratio to receive pantoprazole (40 mg once daily) or matched placebo. Patients on oral anticoagulants were excluded. For permissions please email:
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in patients with escalating cardiovascular symptoms, misdiagnosed as gastrointestinal-related dyspepsia).Although limited direct clinical data are available to evaluate the implications of the aspirin–PPI interaction, one randomized controlled trial did not demonstrate significant excess risk associated with PPIs in patients on DAPT.
For people at: High risk of GI adverse events — a COX-2 inhibitor should be prescribed with a proton pump inhibitor (PPI). A lower dose could still be associated with a protective effect against cancer, as seen in other studies.NSAIDs, statins, low-dose aspirin and PPIs, and the risk of oesophageal adenocarcinoma among patients with Barrett's oesophagus: a population-based case-control study.Aspirin and nonsteroidal anti-inflammatory drug use and the risk of Barrett's esophagus.Whether combination therapy should be offered for patients with Barrett's oesophagus, or even whether prophylactic treatment should be provided for patients with gastro-oesophageal reflux disease to prevent Barrett's oesophagus and reduce the risk of oesophageal adenocarcinoma, is still open for debate. Name must be less than 100 characters Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School
Epub 2015 Feb 25.Chandrasekhar J, Bansilal S, Baber U, Sartori S, Aquino M, Farhan S, Vogel B, Faggioni M, Giustino G, Ariti C, Colombo A, Chieffo A, Kini A, Saporito R, Michael Gibson C, Witzenbichler B, Cohen D, Moliterno D, Stuckey T, Henry T, Pocock S, Dangas G, Gabriel Steg P, Mehran R.Catheter Cardiovasc Interv. Both proton pump inhibitors (PPIs) and clopidogrel are widely prescribed in the Asia‐Pacific population.
Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus 8200, DenmarkMech-Sense, Department of Gastroenterology & Hepatology, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark