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Aspirin vs. P2Y12 Inhibitor Rivalry: Which One Can be Continued During Gastrointestinal Bleeding
Muhammad Begawan Bestari1, Ignatius R Joewono
1Division of Gastroenterohepatology Department of Internal Medicine Faculty of Medicine - University of Padjadjaran Hasan Sadikin General Hospital Bandung - Indonesia. begawanb@yahoo.com.
Insights
Dual antiplatelet therapy (DAPT) reduces cardiovascular events but increases bleeding risk. Guidelines differ on managing gastrointestinal bleeding, with some favoring P2Y12 inhibitors over aspirin.
Area of Science:
- Cardiology
- Gastroenterology
- Pharmacology
Background:
- Dual antiplatelet therapy (DAPT), combining aspirin and a P2Y12 inhibitor, is crucial for secondary prevention after acute coronary syndrome (ACS) and coronary interventions.
- The incidence of DAPT use has risen, increasing the risk of adverse events, notably gastrointestinal bleeding.
Purpose of the Study:
- To review current guidelines for managing gastrointestinal bleeding in patients on DAPT.
- To analyze the evidence supporting the choice of antiplatelet therapy in this high-risk population.
Main Methods:
- Comparative analysis of major cardiology and gastroenterology society guidelines.
- Review of clinical evidence and expert recommendations regarding antiplatelet choice during gastrointestinal bleeding events.
Main Results:
- Most guidelines recommend continuing aspirin while discontinuing P2Y12 inhibitors during gastrointestinal bleeding.
- The 2017 European Society of Cardiologist (ESC) guideline uniquely suggests P2Y12 inhibitors as the preferred agent for upper gastrointestinal bleeding.
Conclusions:
- Discrepancies exist among guidelines regarding optimal antiplatelet management post-gastrointestinal bleeding.
- Further evidence is needed to clarify the best antiplatelet strategy, particularly concerning the ESC's 2017 recommendation.
Abstract:
Dual antiplatelet therapy (DAPT) is the mainstay of secondary prevention treatment for acute coronary syndrome (ACS) and ischemic stroke, especially after coronary intervention. DAPT consists of aspirin and P2Y12 receptor inhibitor (e.g. clopidogrel), and the use of DAPT has been increased over time. The most serious and common adverse effect is gastrointestinal bleeding. Guidelines in managing such condition are available among Gastroenterologist Societies and Cardiologist Societies. Most guidelines are consistent with each other to continue the use of aspirin while withholding P2Y12. However, European Society of Cardiologist (ESC) guideline in 2017 recommends P2Y12 receptor inhibitor as the preferred antiplatelet for patient with upper gastrointestinal bleeding. This review will look on the guidelines and other supporting evidence for the justification on the antiplatelet of choice.
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