How do we manage serious gastrointestinal adverse events associated with anti-thrombotic therapy?

Abstract

Antithrombotic therapy (ATTs) is increasingly used worldwide for preventing primary or recurrent thrombotic events. Moreover, newer oral anti-platelet drugs and anti-coagulants have been introduced for clinical use, accelerating the number of patients under ATT. Not infrequently, these drugs are used in combination. These drugs, however, are well-known for adverse events in which gastrointestinal bleeding (GIB) is most common. Bleeding during ATT can be fatal, but even when patients survive, their prognosis is rather poor. Therefore, it is imperative to minimize such events. So far, co-prescription of proton pump inhibitor (PPI) has been documented to be the most effective in reducing upper GI injury and bleeding, though deliberate use of PPIs is required to minimize drug interaction and associated adverse events with acid suppression. In addition, we should note that PPI is not effective in preventing mid- or lower-GI injury/bleeding for which only limited evidence on preventive measures is available.

Keywords:

• anti-coagulants
• anti-platelet drugs
• anti-thrombotic therapy
• gastrointestinal bleeding
• gastrointestinal ulcer
• proton pump inhibitor

Financial & competing interests disclosure

Sugano K received research grants from Takeda Pharma Inc., Eisai Inc., and Dai-ichi Sankyo Inc. Sugano K also received honoraria for lectureship from Takeda Inc. Sugano K served as an advisory member for clinical trials conducted by Takeda Inc. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.