Optimizing antithrombotic therapy in patients with coexisting cardiovascular and gastrointestinal disease
www.nature.com
March 25, 2024, 3:44 p.m.
Balancing the safety and efficacy of antithrombotic therapy in patients with gastrointestinal disorders is challenging because of the potential for interference with the absorption of antithrombotic drugs or for an increased risk of bleeding. Various clinical states, including malabsorption syndromes, bariatric surgery, short-bowel syndrome or enteral tube feeding, can influence the absorption and bioavailability of oral antithrombotic agents. Bleeding events are an essential prognosticator in patients with cardiovascular diseases — at times as important as thrombotic events — and using antithrombotic agents in patients at high risk of gastrointestinal bleeding (GIB) is very challenging. Most of the existing models to predict the risk of bleeding in patients with coronary artery disease do not estimate the risk of GIB specifically. Identifying patients at high risk of GIB, modifying the bleeding risk by using gastroprotective agents, and determining the appropriate antithrombotic therapy regimen have crucial roles in preventing GIB. After an episode of acute GIB, determining the duration of antithrombotic therapy interruption and the regimen for re-initiation requires consideration of the balance between the bleeding severity and the risk of thrombotic events.