Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

Journal of Gastroenterology, 01/27/2015  Clinical Article

Lanas A, et al. - Proton pump inhibitors seem to be the best gastroprotective agents, whereas the benefits of Helicobacter pylori eradication are still unclear. Low-dose aspirin has additional effects in the gastrointestinal tract. A large body of evidence indicates that it can protect against different cancers, in particular colorectal cancer. This effect could modify the future indications for use of low-dose aspirin and the risk–benefit balance.

·         Low-dose aspirin, alone or combined with other antiplatelet agents, is increasingly prescribed for cardiovascular prevention.

·         However, the cardiovascular benefits should be evaluated together with the gastrointestinal risks.

·         Low-dose aspirin is associated with upper and lower gastrointestinal injury, although lower gastrointestinal effects are poorly characterized.

·         This gastrointestinal risk differs among antiplatelets drugs users.

·         The most important risk factors are history of peptic ulcer, older age, and concomitant use of non-steroidal anti-inflammatory drugs or dual antiplatelet therapy.

·         Effective upper gastrointestinal prevention strategies are available and should be used in at-risk patients taking low-dose aspirin or clopidogrel.

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