Reducing the Risks of Gastrointestinal Bleeding with Antiplatelet Therapies

In the treatment of cardiovascular disease, clinicians commonly are caught between the competing considerations of cardiovascular benefit and gastrointestinal risks. Low-dose aspirin (325 mg or less daily) lowers the risk of cardiovascular and cerebrovascular thrombotic events. Aspirin prevents thromboses and blocks platelet aggregation through inhibition of the cyclooxygenase enzyme, thereby reducing thromboxane synthesis. Owing to the inhibition of cyclooxygenase in the gastrointestinal tract, aspirin also causes gastrointestinal ulceration and major bleeding, which limit its usefulness as an antithrombotic agent.The risk of gastrointestinal bleeding generally increases by a factor of two to three with the use of low-dose aspirin.1 Although . . .