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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Feb 4, 2015; 4(1): 40-46
Published online Feb 4, 2015. doi: 10.5492/wjccm.v4.i1.40
Treatment and prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy
Hiroshi Yasuda, Yasumasa Matsuo, Yoshinori Sato, Sun-ichiro Ozawa, Shinya Ishigooka, Masaki Yamashita, Hiroyuki Yamamoto, Fumio Itoh
Hiroshi Yasuda, Yasumasa Matsuo, Yoshinori Sato, Sun-ichiro Ozawa, Shinya Ishigooka, Masaki Yamashita, Hiroyuki Yamamoto, Fumio Itoh, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
Author contributions: All authors contributed to this work.
Conflict-of-interest: There are no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hiroshi Yasuda, MD, PhD, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, 2-16-1 Sugao, Kawasaki 216-8511, Japan. hyasuda@marianna-u.ac.jp
Telephone: +81-44-9778111 Fax: +81-44-9765805
Received: September 26, 2014
Peer-review started: September 28, 2014
First decision: December 17, 2014
Revised: December 26, 2014
Accepted: January 15, 2015
Article in press: January 15, 2015
Published online: February 4, 2015
Processing time: 137 Days and 23.8 Hours
Abstract

Antiplatelet therapy is the standard of care for the secondary prevention of acute coronary syndrome and ischemic stroke, especially after coronary intervention. However, this therapy is associated with bleeding complications such as gastrointestinal bleeding, which is one of the most common life-threatening complications. Early endoscopy is recommended for most patients with acute upper gastrointestinal bleeding. After successful endoscopic hemostasis, immediate resumption of antiplatelet therapy with proton-pump inhibitors (PPIs) is recommended to prevent further ischemic events. PPI prophylaxis during antiplatelet therapy reduces the risk of upper gastrointestinal bleeding. The potential negative metabolic interaction between PPIs and clopidogrel is still unclear.

Keywords: Antiplatelet therapy; Aspirin; Clopidogrel; Gastrointestinal bleeding; Endoscopy; Proton-pump inhibitor

Core tip: Gastrointestinal bleeding (GIB) is a relatively common complication in patients receiving antiplatelet therapy and is associated with an increased risk of recurrent ischemic events and mortality. Early endoscopy is useful for both the diagnosis and the therapeutic management of GIB. Antiplatelet therapy should be resumed immediately after endoscopic hemostasis of GIB, unless the bleeding is life threatening. Prophylaxis with antisecretory drugs such as proton-pump inhibitors reduces the risk of GIB.