Optimizing antithrombotic therapy in patients with coexisting cardiovascular and gastrointestinal disease

Azita H. Talasaz, Parham Sadeghipour, Luis Ortega-Paz, Hessam Kakavand, Maryam Aghakouchakzadeh, Craig Beavers, John Fanikos, John W. Eikelboom, Deborah M. Siegal, Manuel Monreal, David Jimenez, Muthiah Vaduganathan, Lana A. Castellucci, Adam Cuker, Geoffrey D. Barnes, Jean M. Connors, Eric A. Secemsky, Benjamin W. Van Tassell, Raffaele De Caterina, Jacob E. KurlanderAli Aminian, Gregory Piazza, Samuel Z. Goldhaber, Lisa Moores, Saskia Middeldorp, Ajay J. Kirtane, Mitchell S.V. Elkind, Dominick J. Angiolillo, Stavros Konstantinides, Gregory Y.H. Lip, Gregg W. Stone, Mary Cushman, Harlan M. Krumholz, Roxana Mehran, Deepak L. Bhatt, Behnood Bikdeli*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


Balancing the safety and efficacy of antithrombotic agents in patients with gastrointestinal disorders is challenging because of the potential for interference with the absorption of antithrombotic drugs and for an increased risk of bleeding. In this Review, we address considerations for enteral antithrombotic therapy in patients with cardiovascular disease and gastrointestinal comorbidities. For those with gastrointestinal bleeding (GIB), we summarize a general scheme for risk stratification and clinical evidence on risk reduction approaches, such as limiting the use of concomitant medications that increase the risk of GIB and the potential utility of gastrointestinal protection strategies (such as proton pump inhibitors or histamine type 2 receptor antagonists). Furthermore, we summarize the best available evidence and potential gaps in our knowledge on tailoring antithrombotic therapy in patients with active or recent GIB and in those at high risk of GIB but without active or recent GIB. Finally, we review the recommendations provided by major medical societies, highlighting the crucial role of teamwork and multidisciplinary discussions to customize the antithrombotic regimen in patients with coexisting cardiovascular and gastrointestinal diseases.

Original languageEnglish
JournalNature Reviews Cardiology
StateAccepted/In press - 2024
Externally publishedYes


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