PMID- 33279389 OWN - NLM STAT- MEDLINE DCOM- 20210423 LR - 20210423 IS - 1879-0828 (Electronic) IS - 0953-6205 (Linking) VI - 85 DP - 2021 Mar TI - Gastroprotection in patients on antiplatelet and/or anticoagulant therapy: a position paper of National Association of Hospital Cardiologists (ANMCO) and the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO). PG - 1-13 LID - S0953-6205(20)30424-6 [pii] LID - 10.1016/j.ejim.2020.11.014 [doi] AB - Aspirin and P2Y(12) receptor antagonists are widely used across the spectrum of cardiovascular and cerebrovascular diseases. Gastrointestinal complications, including ulcer and bleeding, are relatively common during antiplatelet treatment and, therefore, concomitant proton pump inhibitor (PPI) treatment is often prescribed. However, potential increased risk of cardiovascular events has been suggested for PPIs, and, in recent years, it has been discussed whether these drugs may reduce the cardiovascular protection by aspirin and, even more so, clopidogrel. Indeed, pharmacodynamic and pharmacokinetic studies suggested an interaction through hepatic CYP2C19 between PPIs and clopidogrel, which could translate into clinical inefficacy, leading to higher rates of cardiovascular events. The FDA and the EMA sent a warning in 2010 discouraging the concomitant use of clopidogrel with omeprazole or esomeprazole. In addition, whether the use of PPIs may affect the clinical efficacy of the new P2Y(12) receptor antagonists, ticagrelor and prasugrel, remains less known. According to current guidelines, PPIs in combination with antiplatelet treatment are recommended in patients with risk factors for gastrointestinal bleeding, including advanced age, concurrent use of anticoagulants, steroids or non-steroidal anti-inflammatory drugs, and Helicobacter pylori infection. Like vitamin K antagonists (VKAs), DOACs can determine gastrointestinal bleeding. Results from both randomized clinical trials and observational studies suggest that high-dose dabigatran (150 mg bid), rivaroxaban and high-dose edoxaban (60 mg daily) are associated with a higher risk of GI bleeding as compared with apixaban and warfarin. In patients taking oral anticoagulant with GI risk factor, PPI could be recommended, even if usefulness of PPIs in these patients deserves further data. Helicobacter pylori should always be searched, and treated, in patients with history of peptic ulcer disease (with or without complication). Given the large number of patients treated with antithrombotic drugs and PPIs, even a minor reduction of platelet inhibition or anticoagulant effect potentially carries a considerable clinical impact. The present joint statement by ANMCO and AIGO summarizes the current knowledge regarding the widespread use of platelet inhibitors, anticoagulants, and PPIs in combination. Moreover, it outlines evidence supporting or opposing drug interactions between these drugs and discusses consequent clinical implications. CI - Copyright (c) 2020. Published by Elsevier B.V. FAU - Abrignani, Maurizio Giuseppe AU - Abrignani MG AD - Cardiology Unit, S. Antonio Abate Hospital, ASP Trapani, Erice, Italy. Electronic address: maur.abri@alice.it. FAU - Gatta, Luigi AU - Gatta L AD - Gastroenterogy Unit, Versilia Hospital, Lido di Camaiore, Italy. FAU - Gabrielli, Domenico AU - Gabrielli D AD - Cardiology Division, Hospital ''Murri", Fermo, Italy. FAU - Milazzo, Giuseppe AU - Milazzo G AD - Department of Medicine, Ospedale Vittorio Emanuele III, Salemi, Italy. FAU - De Francesco, Vincenzo AU - De Francesco V AD - Gastroenterology Unit, 'Riuniti' Hospital, Foggia, Italy. FAU - De Luca, Leonardo AU - De Luca L AD - Dept. Of Cardiosciences, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy. FAU - Francese, Maura AU - Francese M AD - Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy. FAU - Imazio, Massimo AU - Imazio M AD - Cardiology, AOU Citta della Salute e della Scienza, Turin, Italy. FAU - Riccio, Elisabetta AU - Riccio E AD - Department of Transplantation, UOSC of Gastroenterology and Endoscopy, AORN 'A. Cardarelli', Napoli, Italy. FAU - Rossini, Roberta AU - Rossini R AD - Cardiology Unit, Ospedale Santa Croce e Carle, Cuneo, Italy. FAU - Scotto di Uccio, Fortunato AU - Scotto di Uccio F AD - Cardiology Division, Santa Maria Loreto Mare Hospital, Naples, Italy. FAU - Soncini, Marco AU - Soncini M AD - Department of Medicine, ASST Lecco, Italy. FAU - Zullo, Angelo AU - Zullo A AD - Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy. FAU - Colivicchi, Furio AU - Colivicchi F AD - Cardiology Division, San Filippo Neri Hospital, ASL ROMA 1, Rome, Italy. FAU - Di Lenarda, Andrea AU - Di Lenarda A AD - Cardiovascular Center, University Hospital and Health Services of Trieste, Italy. FAU - Gulizia, Michele Massimo AU - Gulizia MM AD - Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy; President, Heart Care Foundation, Italy. FAU - Monica, Fabio AU - Monica F AD - Gastroenterology and Digestive Endoscopy, Academic Hospital Cattinara, Trieste, Italy. LA - eng PT - Journal Article PT - Review DEP - 20201202 PL - Netherlands TA - Eur J Intern Med JT - European journal of internal medicine JID - 9003220 RN - 0 (Anticoagulants) RN - 0 (Platelet Aggregation Inhibitors) RN - 0 (Proton Pump Inhibitors) SB - IM CIN - Eur J Intern Med. 2021 Mar;85:23-24. PMID: 33487506 MH - Anticoagulants/adverse effects MH - *Cardiologists MH - *Gastroenterologists MH - Gastrointestinal Hemorrhage/chemically induced/epidemiology MH - *Helicobacter Infections/complications/drug therapy MH - *Helicobacter pylori MH - Hospitals MH - Humans MH - Italy MH - Platelet Aggregation Inhibitors/adverse effects MH - Proton Pump Inhibitors/therapeutic use OTO - NOTNLM OT - anticoagulant therapy OT - antiplatelet therapy OT - direct oral anticoagulants OT - gastrointestinal bleeding OT - proton pump inhibitors, Helicobacter pylori EDAT- 2020/12/07 06:00 MHDA- 2021/04/24 06:00 CRDT- 2020/12/06 20:41 PHST- 2020/08/11 00:00 [received] PHST- 2020/11/03 00:00 [revised] PHST- 2020/11/16 00:00 [accepted] PHST- 2020/12/07 06:00 [pubmed] PHST- 2021/04/24 06:00 [medline] PHST- 2020/12/06 20:41 [entrez] AID - S0953-6205(20)30424-6 [pii] AID - 10.1016/j.ejim.2020.11.014 [doi] PST - ppublish SO - Eur J Intern Med. 2021 Mar;85:1-13. doi: 10.1016/j.ejim.2020.11.014. Epub 2020 Dec 2.