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. Kurlander; Ali 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

doi:10.1038/s41569-024-01003-3

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 journal › Review article › peer-review

5 Scopus citations

Abstract

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 language	English
Pages (from-to)	574-592
Number of pages	19
Journal	Nature Reviews Cardiology
Volume	21
Issue number	8
DOIs	https://doi.org/10.1038/s41569-024-01003-3
State	Published - Aug 2024
Externally published	Yes

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Talasaz, A. H., Sadeghipour, P., Ortega-Paz, L., Kakavand, H., Aghakouchakzadeh, M., Beavers, C., Fanikos, J., Eikelboom, J. W., Siegal, D. M., Monreal, M., Jimenez, D., Vaduganathan, M., Castellucci, L. A., Cuker, A., Barnes, G. D., Connors, J. M., Secemsky, E. A., Van Tassell, B. W., De Caterina, R., ... Bikdeli, B. (2024). Optimizing antithrombotic therapy in patients with coexisting cardiovascular and gastrointestinal disease. Nature Reviews Cardiology, 21(8), 574-592. https://doi.org/10.1038/s41569-024-01003-3

@article{7497ffeb4c3c49158ba9ac49b157504d,

title = "Optimizing antithrombotic therapy in patients with coexisting cardiovascular and gastrointestinal disease",

abstract = "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.",

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

note = "Publisher Copyright: {\textcopyright} Springer Nature Limited 2024.",

year = "2024",

month = aug,

doi = "10.1038/s41569-024-01003-3",

language = "English",

volume = "21",

pages = "574--592",

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Talasaz, AH, Sadeghipour, P, Ortega-Paz, L, Kakavand, H, Aghakouchakzadeh, M, Beavers, C, Fanikos, J, Eikelboom, JW, Siegal, DM, Monreal, M, Jimenez, D, Vaduganathan, M, Castellucci, LA, Cuker, A, Barnes, GD, Connors, JM, Secemsky, EA, Van Tassell, BW, De Caterina, R, Kurlander, JE, Aminian, A, Piazza, G, Goldhaber, SZ, Moores, L, Middeldorp, S, Kirtane, AJ, Elkind, MSV, Angiolillo, DJ, Konstantinides, S, Lip, GYH, Stone, GW, Cushman, M, Krumholz, HM, Mehran, R, Bhatt, DL & Bikdeli, B 2024, 'Optimizing antithrombotic therapy in patients with coexisting cardiovascular and gastrointestinal disease', Nature Reviews Cardiology, vol. 21, no. 8, pp. 574-592. https://doi.org/10.1038/s41569-024-01003-3

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T1 - Optimizing antithrombotic therapy in patients with coexisting cardiovascular and gastrointestinal disease

AU - Talasaz, Azita H.

AU - Sadeghipour, Parham

AU - Ortega-Paz, Luis

AU - Kakavand, Hessam

AU - Aghakouchakzadeh, Maryam

AU - Beavers, Craig

AU - Fanikos, John

AU - Eikelboom, John W.

AU - Siegal, Deborah M.

AU - Monreal, Manuel

AU - Jimenez, David

AU - Vaduganathan, Muthiah

AU - Castellucci, Lana A.

AU - Cuker, Adam

AU - Barnes, Geoffrey D.

AU - Connors, Jean M.

AU - Secemsky, Eric A.

AU - Van Tassell, Benjamin W.

AU - De Caterina, Raffaele

AU - Kurlander, Jacob E.

AU - Aminian, Ali

AU - Piazza, Gregory

AU - Goldhaber, Samuel Z.

AU - Moores, Lisa

AU - Middeldorp, Saskia

AU - Kirtane, Ajay J.

AU - Elkind, Mitchell S.V.

AU - Angiolillo, Dominick J.

AU - Konstantinides, Stavros

AU - Lip, Gregory Y.H.

AU - Stone, Gregg W.

AU - Cushman, Mary

AU - Krumholz, Harlan M.

AU - Mehran, Roxana

AU - Bhatt, Deepak L.

AU - Bikdeli, Behnood

PY - 2024/8

Y1 - 2024/8

N2 - 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.

AB - 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.

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DO - 10.1038/s41569-024-01003-3

M3 - Review article

AN - SCOPUS:85188154243

SN - 1759-5002

VL - 21

SP - 574

EP - 592

JO - Nature Reviews Cardiology

JF - Nature Reviews Cardiology

IS - 8

ER -

Optimizing antithrombotic therapy in patients with coexisting cardiovascular and gastrointestinal disease

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