Практическое руководство American Society of Gastrointestinal Endoscopy (98) по использованию антиагрегантов и антикоагулянтов под контролем ЖК эндоскопии GI рассматривает риски и пользу антиагрегационной терапии с использованием ЖК эндоскопии. Сердечно-сосудистые проблемы должны оставаться главными в ЖК практике эндоскописта; таким образом, сердечно-сосудистый риск перевешивает в клиническом принятии решения. В то же время много эндоскопистов предпочли бы отказаться от двойной антиагрегационной терапии под контролем плановой колоноскопии и полипэктомии,
фактическое свидетельство, что эта практика уменьшает риск постполипэктомического кровотечения, является крайним (98). Поэтому, мы поощряем эндоскопистов, рассматривать сердечно-сосудистые риски,
и отсрочить плановые процедуры у пациентов с высоким риском (например, с недавно установленными сердечно-сосудистыми стентами), например, в течение года после размещения drug-eluting стента. Важно подчеркнуть что руководство не призывает прекращать АСК или НПВП для большинства эндоскопических процедур из-за нехватки ясных данных, что эндоскопические процедуры, такие как полипэктомия неблагоприятно влияют на частоту кровотечений.
Наиболее вероятное решение проблемы возможного прекращения антиагрегантов у пациента с высоким риском возможно при проведении эндоскопической терапии при ЖК кровотечении. Это возможно не так часто, и снова главной должна быть индивидуальная стратификация риска. На основании консенсуса экспертов комитета авторов, тем, у кого хроническая потеря крови и высокий сердечно-сосудистый риск, такой как недавно помещенный стент, двойная антиагрегантная терапия должна быть продолжена как диктует сердечно-сосудистый риск, учитывая отстутствие ясно определенных противопоказаний к эндоскопическому вмешательству.
В остром случае после успешного эндоскопического лечения большого ЖК кровоизлияния, будет благоразумным обсудить следующее, ненадолго прекратить антиагрегационную терапию, пока не убедимся, что нет ре-кровотечения в отделения интенсивной терапии. Оптимальная продолжительность прекращения антиагрегантной терапии, приводящая к равновесию ЖК и сердечно-сосудистые прогнозы, не была
установлена клиническими исследованиями. Текущая эффективность эндоскопической терапии при язвенном кровотечении в объединении с внутривенной непрерывной терапией ИПП предполагает повторное включение антиагрегантной терапии у пациентов с высоким сердечно-сосудистом риском, что разумно у тех, у кого нет ре-кровотечения после 3 - 7 дней (97). В намного менее частом случае эндоскопической терапии для кровотечения нижних отделов ЖКТ данные для принятия решения еще менее доступны. Там, где не ведется добавочная противоязвенная медикаментозная терапии ИНН при язвенном кровотечении,
эндоскописты могут использовать нетепловое лечение, такое как клиппирование и использовать паузу а антиагрегационной терапии в течение 7 - 10 дней, исходя из размера повреждения и индивидуальной
оценке адекватности эндоскопической терапии.
Резюме
У соответствующих пациентов пероральная антиагрегационная терапии уменьшает ишемические риски, но эта терапия может вызвать увеличение частоты кровотечений. Из возникающих больших кровотечений чаще всего случаются ЖК кровоизлияния. Сопутствующее использование НПВП еще больше повышает риск ЖК кровотечения. Гастропротекторная стратегии состоят из использования ИПП у пациентов с высоким риском ЖК кровотечения и эрадикация H.pylori у пациентов с язвенным анамнезом. Общение между кардиологами, гастроэнтерологами и врачами общей практики очень важно для того, чтобы взвесить ишемические риски и риски кровотечения индивидуально у каждого пациента, который нуждается в антиагрегационной терапии, но при этом существует опасность существенного ЖК кровотечения.
REFERENCES
1. Antman EM, Hand M, Armstrong PW, et al. 2007 focused update of
the ACC/AHA 2004 guidelines for the management of patients with
ST-elevation myocardial infarction: a report of the American College
of Cardiology/American Heart Association Task Force on Practice
Guidelines (Writing Group to Review New Evidence and Update the
ACC/AHA 2004 Guidelines for the Management of Patients With
ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;51:
210–47.
2. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007
guidelines for the management of patients with unstable angina/non-
ST-elevation myocardial infarction: a report of the American College
of Cardiology/American Heart Association Task Force on Practice
Guidelines (Writing Committee to Revise the 2002 Guidelines for the
Management of Patients With Unstable Angina/Non-ST-Elevation
Myocardial Infarction): developed in collaboration with the American
College of Emergency Physicians, the Society for Cardiovascular
Angiography and Interventions, and the Society of Thoracic Surgeons
endorsed by the American Association of Cardiovascular and Pulmonary
Rehabilitation and the Society for Academic Emergency Medicine.
J Am Coll Cardiol. 2007;50:e1–157.
3. Grines CL, Bonow RO, Casey DE Jr., et al. Prevention of premature
discontinuation of dual antiplatelet therapy in patients with coronary
artery stents: a science advisory from the American Heart Association,
American College of Cardiology, Society for Cardiovascular Angiography
and Interventions, American College of Surgeons, and American
Dental Association, with representation from the American
College of Physicians. J Am Coll Cardiol. 2007;49:734 –9.
4. Bavry AA, Bhatt DL. Appropriate use of drug-eluting stents: balancing
the reduction in restenosis with the concern of late thrombosis.
Lancet. 2008;371:2134–43.
5. Antman EM, Bennett JS, Daugherty A, Furberg C, Roberts H,
Taubert KA. Use of nonsteroidal antiinflammatory drugs: an update
for clinicians: a scientific statement from the American Heart Association.
Circulation. 2007;115:1634–42.
6. Bhatt DL. NSAIDS and the risk of myocardial infarction: do they
help or harm? Eur Heart J. 2006;27:1635– 6.
7. Antman EM, DeMets D, Loscalzo J. Cyclooxygenase inhibition and
cardiovascular risk. Circulation. 2005;112:759 –70.
8. Abraham NS, El-Serag HB, Johnson ML, et al. National adherence to
evidence-based guidelines for the prescription of nonsteroidal antiinflammatory
drugs. Gastroenterology. 2005;129:1171– 8.
9. Talley NJ, Evans JM, Fleming KC, Harmsen WS, Zinsmeister AR,
Melton LJ III. Nonsteroidal antiinflammatory drugs and dyspepsia in
the elderly. Dig Dis Sci. 1995;40:1345–50.
10. Shaheen NJ, Hansen RA, Morgan DR, et al. The burden of gastrointestinal
and liver diseases, 2006. Am J Gastroenterol. 2006;101:
2128–38.
11. Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the
prevalence of arthritis and selected musculoskeletal disorders in the
United States. Arthritis Rheum. 1998;41:778 –99.
12. Scheiman JM. NSAIDs, gastrointestinal injury, and cytoprotection.
Gastroenterol Clin North Am. 1996;25:279 –98.
13. Lanas A, Scheiman J. Low-dose aspirin and upper gastrointestinal
damage: epidemiology, prevention and treatment. Curr Med Res
Opin. 2007;23:163–73.
14. Wallace JL, McKnight W, Reuter BK, Vergnolle N. NSAID-induced
gastric damage in rats: requirement for inhibition of both cyclooxygenase
1 and 2. Gastroenterology. 2000;119:706 –14.
15. Cox ER, Frisse M, Behm A, Fairman KA. Over-the-counter pain
reliever and aspirin use within a sample of long-term cyclooxygenase 2
users. Arch Intern Med. 2004;164:1243– 6.
16. Abraham NS, El-Serag HB, Hartman C, Richardson P, Deswal A.
Cyclooxygenase-2 selectivity of non-steroidal anti-inflammatory drugs
and the risk of myocardial infarction and cerebrovascular accident.
Aliment Pharmacol Ther. 2007;25:913–24.
17. Ma L, Elliott SN, Cirino G, Buret A, Ignarro LJ, Wallace JL.
Platelets modulate gastric ulcer healing: role of endostatin and vascular
endothelial growth factor release. Proc Natl Acad Sci U S A.
2001;98:6470 –5.
18. Kabbinavar F, Hurwitz HI, Fehrenbacher L, et al. Phase II, randomized
trial comparing bevacizumab plus fluorouracil (FU)/leucovorin
(LV) with FU/LV alone in patients with metastatic colorectal cancer.
J Clin Oncol. 2003;21:60 –5.
19. Bombardier C, Laine L, Reicin A, et al. Comparison of upper
gastrointestinal toxicity of rofecoxib and naproxen in patients with
rheumatoid arthritis: VIGOR Study Group. N Engl J Med. 2000;343:
1520–8.
20. Griffin MR, Ray WA, Schaffner W. Nonsteroidal anti-inflammatory
drug use and death from peptic ulcer in elderly persons. Ann Intern
Med. 1988;109:359–63.
21. Griffin MR, Piper JM, Daugherty JR, Snowden M, Ray WA.
Nonsteroidal anti-inflammatory drug use and increased risk for peptic
ulcer disease in elderly persons. Ann Intern Med. 1991;114:257– 63.
22. Smalley WE, Ray WA, Daugherty JR, Griffin MR. Nonsteroidal
anti-inflammatory drugs and the incidence of hospitalizations for
peptic ulcer disease in elderly persons. Am J Epidemiol. 1995;141:
539–45.
23. Hawkey CJ, Talley NJ, Scheiman JM, et al. Maintenance treatment
with esomeprazole following initial relief of non-steroidal antiinflammatory
drug-associated upper gastrointestinal symptoms: the
NASA2 and SPACE2 studies. Arthritis Res Ther. 2007;9:R17.
24. Ofman JJ, MacLean CH, Straus WL, et al. A meta-analysis of severe
upper gastrointestinal complications of nonsteroidal antiinflammatory
drugs. J Rheumatol. 2002;29:804 –12.
25. Singh G, Triadafilopoulos G. Epidemiology of NSAID induced
gastrointestinal complications. J Rheumatol Suppl. 1999;56:18 –24.
26. Abraham NS, Castillo DL, Hartman C. National mortality following
upper gastrointestinal or cardiovascular events in older veterans with
recent nonsteroidal anti-inflammatory drug use. Aliment Pharmacol
Ther. 2008;28:97–106.
27. Fries JF, Murtagh KN, Bennett M, Zatarain E, Lingala B, Bruce B.
The rise and decline of nonsteroidal anti-inflammatory drugassociated
gastropathy in rheumatoid arthritis. Arthritis Rheum. 2004;
50:2433– 40.
28. Hallas J, Dall M, Andries A, et al. Use of single and combined
antithrombotic therapy and risk of serious upper gastrointestinal
bleeding: population based case-control study. BMJ. 2006;333:726.
29. Johnson DA. Upper GI risks of NSAIDs and antiplatelet agents: key
issues for the cardiologist. Rev Cardiovasc Med. 2005;6 Suppl 4:
S15–22.
30. Abraham NS, Hartman C, Castillo D, Richardson P, Smalley W.
Effectiveness of national provider prescription of PPI gastroprotection
among elderly NSAID users. Am J Gastroenterol. 2008;103:323–32.
31. Lanas A, Bajador E, Serrano P, et al. Nitrovasodilators, low-dose
aspirin, other nonsteroidal antiinflammatory drugs, and the risk of
upper gastrointestinal bleeding. N Engl J Med. 2000;343:834 –9.
32. Scheiman JM, Fendrick AM. Summing the risk of NSAID therapy.
Lancet. 2007;369:1580 –1.
33. Pearson TA, Blair SN, Daniels SR, et al. AHA guidelines for primary
prevention of cardiovascular disease and stroke: 2002 update: Consensus
Panel Guide to Comprehensive Risk Reduction for Adult Patients
Without Coronary or Other Atherosclerotic Vascular Diseases.
American Heart Association Science Advisory and Coordinating
Committee. Circulation. 2002;106:388 –91.
34. Mosca L, Banka CL, Benjamin EJ, et al. Evidence-based guidelines
for cardiovascular disease prevention in women: 2007 update. Circulation.
2007;115:1481–501.
35. Hayden M, Pignone M, Phillips C, Mulrow C. Aspirin for the
primary prevention of cardiovascular events: a summary of the evidence
for the U.S. Preventive Services Task Force. Ann Intern Med.
2002;136:161–72.
36. Chan FK, Graham DY. Review article: prevention of non-steroidal
anti-inflammatory drug gastrointestinal complications–review and recommendations
based on risk assessment. Aliment Pharmacol Ther.
2004;19:1051– 61.
37. Weil J, Colin-Jones D, Langman M, et al. Prophylactic aspirin and
risk of peptic ulcer bleeding. BMJ. 1995;310:827–30.
38. Yeomans ND, Lanas AI, Talley NJ, et al. Prevalence and incidence of
gastroduodenal ulcers during treatment with vascular protective doses
of aspirin. Aliment Pharmacol Ther. 2005;22:795– 801.
39. de Abajo FJ, Garcia Rodriguez LA. Risk of upper gastrointestinal
bleeding and perforation associated with low-dose aspirin as plain and
enteric-coated formulations. BMC Clin Pharmacol. 2001;1:1.
40. Kelly JP, Kaufman DW, Jurgelon JM, Sheehan J, Koff RS, Shapiro S.
Risk of aspirin-associated major upper-gastrointestinal bleeding with
enteric-coated or buffered product. Lancet. 1996;348:1413– 6.
41. McQuaid KR, Laine L. Systematic review and meta-analysis of
adverse events of low-dose aspirin and clopidogrel in randomized
controlled trials. Am J Med. 2006;119:624 –38.
42. Hernandez-Diaz S, Garcia Rodriguez LA. Cardioprotective aspirin
users and their excess risk of upper gastrointestinal complications.
BMC Med. 2006;4:22.
43. Sorensen HT, Mellemkjaer L, Blot WJ, et al. Risk of upper gastrointestinal
bleeding associated with use of low-dose aspirin. Am J
Gastroenterol. 2000;95:2218 –24.
44. Wilcox CM, Shalek KA, Cotsonis G. Striking prevalence of over-thecounter
nonsteroidal anti-inflammatory drug use in patients with
upper gastrointestinal hemorrhage. Arch Intern Med. 1994;154:42– 6.
45. Derry S, Loke YK. Risk of gastrointestinal haemorrhage with long
term use of aspirin: meta-analysis. BMJ. 2000;321:1183–7.
46. Laine L, McQuaid K. Bleeding complications related to aspirin dose.
Am J Cardiol. 2005;96:1035– 6.
47. Serebruany VL, Steinhubl SR, Berger PB, et al. Analysis of risk of
bleeding complications after different doses of aspirin in 192,036
patients enrolled in 31 randomized controlled trials. Am J Cardiol.
2005;95:1218 –22.
48. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis
of randomised trials of antiplatelet therapy for prevention of death,
myocardial infarction, and stroke in high risk patients. BMJ. 2002;
324:71– 86.
49. Peters RJ, Mehta SR, Fox KA, et al. Effects of aspirin dose when used
alone or in combination with clopidogrel in patients with acute
coronary syndromes: observations from the Clopidogrel in Unstable
angina to prevent Recurrent Events (CURE) study. Circulation.
2003;108:1682–7.
50. Garcia Rodriguez LA, Hernandez-Diaz S, de Abajo FJ. Association
between aspirin and upper gastrointestinal complications: systematic
review of epidemiologic studies. Br J Clin Pharmacol. 2001;52:
563–71.
51. Berger JS, Stebbins A, Granger CB, et al. Initial aspirin dose and
outcome among ST-elevation myocardial infarction patients treated
with fibrinolytic therapy. Circulation. 2008;117:192–9.
52. King SB III, Smith SC Jr., Hirshfeld JW Jr., et al. 2007 focused update
of the ACC/AHA/SCAI 2005 guideline update for percutaneous
coronary intervention: a report of the American College of Cardiology/
American Heart Association Task Force on Practice Guidelines (2007
Writing Group to Review New Evidence and Update the 2005
ACC/AHA/SCAI Guideline Update for Percutaneous Coronary
Intervention). J Am Coll Cardiol. 2008;51:172–209.
53. Eikelboom JW, Hirsh J. Combined antiplatelet and anticoagulant
therapy: clinical benefits and risks. J Thromb Haemost. 2007;5 Suppl
1:255– 63.
54. Lanas A, Serrano P, Bajador E, Fuentes J, Sainz R. Risk of upper
gastrointestinal bleeding associated with non-aspirin cardiovascular
drugs, analgesics and nonsteroidal anti-inflammatory drugs. Eur J
Gastroenterol Hepatol. 2003;15:173– 8.
55. Taha AS, Angerson WJ, Knill-Jones RP, Blatchford O. Upper
gastrointestinal haemorrhage associated with low-dose aspirin and
antithrombotic drugs - a 6-year analysis and comparison with nonsteroidal
anti-inflammatory drugs. Aliment Pharmacol Ther. 2005;22:
285–9.
56. Younossi ZM, Strum WB, Schatz RA, Teirstein PS, Cloutier DA,
Spinks TJ. Effect of combined anticoagulation and low-dose aspirin
treatment on upper gastrointestinal bleeding. Dig Dis Sci. 1997;42:
79–82.
57. Collins R, MacMahon S, Flather M, et al. Clinical effects of
anticoagulant therapy in suspected acute myocardial infarction: systematic
overview of randomised trials. BMJ. 1996;313:652–9.
58. Fragmin during Instability in Coronary Artery Disease (FRISC) study
group. Low-molecular-weight heparin during instability in coronary
artery disease. Lancet. 1996;347:561– 8.
59. Yusuf S, Mehta SR, Xie C, et al. Effects of reviparin, a low-molecularweight
heparin, on mortality, reinfarction, and strokes in patients with
acute myocardial infarction presenting with ST-segment elevation.
JAMA. 2005;293:427–35.
60. Andreotti F, Testa L, Biondi-Zoccai GG, Crea F. Aspirin plus
warfarin compared to aspirin alone after acute coronary syndromes: an
updated and comprehensive meta-analysis of 25,307 patients. Eur
Heart J. 2006;27:519 –26.
61. Hirsh J, Guyatt G, Albers GW, Harrington RA, Schunemann HJ.
Executive summary: American College of Chest Physicians evidencebased
clinical practice guidelines (8th edition). Chest. 2008;133:71–
109.
62. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel
versus aspirin in patients at risk of ischaemic events (CAPRIE).
Lancet. 1996;348:1329 –39.
63. Bhatt DL, Hirsch AT, Ringleb PA, Hacke W, Topol EJ. Reduction
in the need for hospitalization for recurrent ischemic events and
bleeding with clopidogrel instead of aspirin. CAPRIE investigators.
Am Heart J. 2000;140:67–73.
64. Gluckman TJ, Baranowski B, Ashen MD, et al. A practical and
evidence-based approach to cardiovascular disease risk reduction. Arch
Intern Med. 2004;164:1490 –500.
65. Grines CL, Bonow RO, Casey DE Jr., et al. Prevention of premature
discontinuation of dual antiplatelet therapy in patients with coronary
artery stents: a science advisory from the American Heart Association,
American College of Cardiology, Society for Cardiovascular Angiography
and Interventions, American College of Surgeons, and American
Dental Association, with representation from the American
College of Physicians. Circulation. 2007;115:813– 8.
66. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK.
Effects of clopidogrel in addition to aspirin in patients with acute
coronary syndromes without ST-segment elevation. N Engl J Med.
2001;345:494 –502.
67. Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel
compared with clopidogrel alone after recent ischaemic stroke or
transient ischaemic attack in high-risk patients (MATCH): randomised,
double-blind, placebo-controlled trial. Lancet. 2004;364:331–7.
68. Bhatt DL, Fox KA, Hacke W, et al. Clopidogrel and aspirin versus
aspirin alone for the prevention of atherothrombotic events. N Engl
J Med. 2006;354:1706 –17.
69. Bhatt DL. Intensifying platelet inhibition–navigating between Scylla
and Charybdis. N Engl J Med. 2007;357:2078–81.
70. Bavry AA, Bhatt DL. Drug-eluting stents: dual antiplatelet therapy
for every survivor? Circulation. 2007;116:696 –9.
71. Sheikh RA, Romano PS, Prindiville TP, Yasmeen S, Trudeau W.
Endoscopic evidence of mucosal injury in patients taking ticlopidine
compared with patients taking aspirin/nonsteroidal antiinflammatory
drugs and controls. J Clin Gastroenterol. 2002;34:529 –32.
72. Fork FT, Lafolie P, Toth E, Lindgarde F. Gastroduodenal tolerance
of 75 mg clopidogrel versus 325 mg aspirin in healthy volunteers: a
gastroscopic study. Scand J Gastroenterol. 2000;35:464 –9.
73. Lanas A, Garcia-Rodriguez LA, Arroyo MT, et al. Risk of upper
gastrointestinal ulcer bleeding associated with selective cyclooxygenase-
2 inhibitors, traditional non-aspirin non-steroidal antiinflammatory
drugs, aspirin and combinations. Gut. 2006;55:1731– 8.
74. Chan FK, Ching JY, Hung LC, et al. Clopidogrel versus aspirin and
esomeprazole to prevent recurrent ulcer bleeding. N Engl J Med.
2005;352:238–44.
75. Lai KC, Chu KM, Hui WM, et al. Esomeprazole with aspirin versus
clopidogrel for prevention of recurrent gastrointestinal ulcer complications.
Clin Gastroenterol Hepatol. 2006;4:860 –5.
76. Lanas A, Garcia-Rodriguez LA, Arroyo MT, et al. Effect of antisecretory
drugs and nitrates on the risk of ulcer bleeding associated with
nonsteroidal anti-inflammatory drugs, antiplatelet agents, and anticoagulants.
Am J Gastroenterol. 2007;102:507–15.
77. Anand S, Yusuf S, Xie C, et al. Oral anticoagulant and antiplatelet
therapy and peripheral arterial disease. N Engl J Med. 2007;357:
217–27.
78. Khurram Z, Chou E, Minutello R, et al. Combination therapy with
aspirin, clopidogrel and warfarin following coronary stenting is associated
with a significant risk of bleeding. J Invasive Cardiol. 2006;18:
162–4.
79. Donnelly MT, Goddard AF, Filipowicz B, Morant SV, Shield MJ,
Hawkey CJ. Low-dose misoprostol for the prevention of low-dose
aspirin-induced gastroduodenal injury. Aliment Pharmacol Ther.
2000;14:529 –34.
80. Goldstein JL, Huang B, Amer F, Christopoulos NG. Ulcer recurrence
in high-risk patients receiving nonsteroidal anti-inflammatory drugs
plus low-dose aspirin: results of a post HOC subanalysis. Clin Ther.
2004;26:1637– 43.
81. Silverstein FE, Graham DY, Senior JR, et al. Misoprostol reduces
serious gastrointestinal complications in patients with rheumatoid
arthritis receiving nonsteroidal anti-inflammatory drugs: a randomized,
double-blind, placebo-controlled trial. Ann Intern Med. 1995;
123:241–9.
82. Kitchingman GK, Prichard PJ, Daneshmend TK, Walt RP, Hawkey
CJ. Enhanced gastric mucosal bleeding with doses of aspirin used for
prophylaxis and its reduction by ranitidine. Br J Clin Pharmacol.
1989;28:581–5.
83. Cole AT, Brundell S, Hudson N, Hawthorne AB, Mahida YR,
Hawkey CJ. Ranitidine: differential effects on gastric bleeding and
mucosal damage induced by aspirin. Aliment Pharmacol Ther. 1992;
6:707–15.
84. Chin MW, Yong G, Bulsara MK, Rankin J, Forbes GM. Predictive
and protective factors associated with upper gastrointestinal bleeding
after percutaneous coronary intervention: a case-control study. Am J
Gastroenterol. 2007;102:2411– 6.
85. Lai KC, Lam SK, Chu KM, et al. Lansoprazole for the prevention of
recurrences of ulcer complications from long-term low-dose aspirin
use. N Engl J Med. 2002;346:2033– 8.
86. Chan FK, Chung SC, Suen BY, et al. Preventing recurrent upper
gastrointestinal bleeding in patients with Helicobacter pylori infection
who are taking low-dose aspirin or naproxen. N Engl J Med.
2001;344:967–73.
87. Lanas A, Rodrigo L, Marquez JL, et al. Low frequency of upper
gastrointestinal complications in a cohort of high-risk patients taking
low-dose aspirin or NSAIDS and omeprazole. Scand J Gastroenterol.
2003;38:693–700.
88. Scheiman JM, Yeomans ND, Talley NJ, et al. Prevention of ulcers by
esomeprazole in at-risk patients using non-selective NSAIDs and
COX-2 inhibitors. Am J Gastroenterol. 2006;101:701–10.
89. Gilard M, Arnaud B, Cornily JC, et al. Influence of omeprazole on the
antiplatelet action of clopidogrel associated with aspirin: the randomized,
double-blind OCLA (Omeprazole CLopidogrel Aspirin) study.
J Am Coll Cardiol. 2008;51:256–60.
90. Trenk D, Hochholzer W, Fromm MF, et al. Cytochrome P450 2C19
681G_A polymorphism and high on-clopidogrel platelet reactivity
associated with adverse 1-year clinical outcome of elective percutaneous
coronary intervention with drug-eluting or bare-metal stents. J Am
Coll Cardiol. 2008;51:1925–34.
91. Lanas A, Fuentes J, Benito R, Serrano P, Bajador E, Sainz R.
Helicobacter pylori increases the risk of upper gastrointestinal bleeding
in patients taking low-dose aspirin. Aliment Pharmacol Ther. 2002;
16:779–86.
92. Stack WA, Atherton JC, Hawkey GM, Logan RF, Hawkey CJ.
Interactions between Helicobacter pylori and other risk factors for
peptic ulcer bleeding. Aliment Pharmacol Ther. 2002;16:497–506.
93. Chan FK. Long-term incidence of ulcer bleeding with low-dose
aspiring after eradication of H. pylori: a 4-year prospective cohort
study (abstr). Gastroenterology. 2005;128:A133.
94. Chey WD, Wong BC. American College of Gastroenterology guideline
on the management of Helicobacter pylori infection. Am J
Gastroenterol. 2007;102:1808 –25.
95. Dorward S, Sreedharan A, Leontiadis GI, Howden CW, Moayyedi P,
Forman D. Proton pump inhibitor treatment initiated prior to endoscopic
diagnosis in upper gastrointestinal bleeding. Cochrane Database
Syst Rev. 2006;CD005415.
96. Green FW Jr., Kaplan MM, Curtis LE, Levine PH. Effect of acid and
pepsin on blood coagulation and platelet aggregation: a possible
contributor prolonged gastroduodenal mucosal hemorrhage. Gastroenterology.
1978;74:38–43.
97. Sung J, Lau J, Ching J, et al. Can aspirin be reintroduced with PPI
inhibitor INFUSION after endoscopic hemostatis: a double-blinded
randomized controlled trial (abstr). Gastroenterology. 2008;130:A44.
98. Eisen GM, Baron TH, Dominitz JA, et al. Guideline on the
management of anticoagulation and antiplatelet therapy for endoscopic
procedures. Gastrointest Endosc. 2002;55:775–9.
Key Words: ACCF Expert Consensus Document y gastrointestinal risk
y antiplatelet therapy y NSAID y gastroduodenal ulcer y
gastrointestinal bleeding y aspirin y stents y thrombosis.