Position paper of the working group of three Polish national consultants in internal medicine, gastroenterology, and cardiology on prevention of gastrointestinal complications during antiplatelet treatment.

347 At the end of 2008, the experts of American Col­ lege of Cardiology Foundation (ACCF), American Heart Association (AHA), and American College of Gastroenterology (ACG) published a joint po­ sition statement which encompassed the recom­ mendations for reduction in gastrointestinal com­ plications, particularly gastrointestinal hemo­ rrhage, in patients on antiplatelet therapy.1 Since no such document has been prepared by the Euro­ pean institutions, knowledge of the above recom­ mendations appears highly important. Therefore, the members of the ad hoc Polish Working Group advise that the recommendations should be dis­ seminated and implemented in Poland. Numerous observations have confirmed the presence of patient groups at high risk of gas­ trointestinal complications during antiplatelet treatment. The major risk factor is a history of peptic ulcer disease, particularly with bleeding complications. The risk of gastrointestinal compli­ cations also increases with age, especially in sub­ jects aged >60 years. It is also higher in patients with a prior history of bleeding from other sites than the gastrointestinal tract, in women, in pa­ tients with concomitant renal insufficiency, in pa­ tients on glucocorticosteroids and non­steroidal anti­inflammatory drugs, and in patients with dyspepsia or symptoms of gastroesophageal reflux disease. Complications occur far more frequent­ ly during combined therapy with an antiplatelet agent and an anticoagulant. It refers mostly to pa­ tients on intensive antiplatelet and anticoagulant therapy, including those with an acute coronary syndrome. Therefore, it is necessary that special­ ists in inter nal diseases, gastroenterology, and cardiology adopt a joint strategy to prevent gas­ trointestinal bleeding complications. In most patients who are treated with acetyl­ salicylic acid (ASA) for the prevention of cardio­ vascular events, low doses of this drug should be administered. It has been demonstrated that 75–160 mg daily doses of ASA were as effective as higher doses. No further decrease in the risk of cardiovascular events was observed at higher doses of ASA, although there was a significant increase in complication rate. Therefore, the rou­ tine ASA administration of 75 mg/day for car­ diovascular indications should be recommend­ ed. Proton pump inhibitors (PPIs) are the only recommended class of drugs with proven effica­ cy in the prevention of gastrointestinal complica­ tions. Easy dosage (once a day) and an extremely low rate of adverse effects contributed to wide­ spread use of PPIs. The efficacy of PPIs has been shown in multiple studies designed to evaluate gastroscopic lesions and the incidence of gastro­ intestinal bleedings. In a joint document, ACCF/AHA and ACG pub­ lished an outline algorithm to prevent gastroin­ testinal complications in patients receiving anti­ platelet therapy (FIGURE). The experts make pro­ phylactic treatment dependent on the presence of risk factors. They recommend PPI adminis­ tration as a preventive measure in patients with EDITORIAL