ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use

“The flurry of conflicting data published following the 2008 Expert Consensus Document left many practitioners confused. However, much of the published data used results of platelet function tests as surrogate markers of cardiovascular risk. The differences in drug levels and in platelet function studies caused concern about an adverse drug interaction, but the clinical significance of these laboratory test results has not been substantiated when held to the higher scientific standard of large patient studies with clinically relevant endpoints, such as heart attacks or strokes.”

Mark HlatkyProfessor of cardiovascular medicine, Stanford University

“In patients at high risk of GI bleeding who require antiplatelet therapy for heart disease, the balance of risk and benefit favor use of proton-pump inhibitors. In patients at low risk of GI bleeding, however, the balance of risk and benefit tips away from using proton-pump inhibitors together with antiplatelet drugs.”

Deepak L. BhattChief of Cardiology, VA Boston Healthcare System

“Further research is needed to define the optimal strategy to reduce GI events in patients on antithrombotic therapy, though prophylactic PPI use seems promising.”