Evaluation of Efficacy of Antisecretory Agents in Prevention of Gastrointestinal Complications Associated with Prolonged Antiplatelet Therapy

Abstract

Acute coronary syndromes (ACS) are the leading cause of mortality and one of the main reasons for hospital admissions in many countries. Due to high rates of mortality and re-infarction, it represents a major public health concern. Atherothrombosis, thrombus formation as a result of atherosclerotic plaque rupture, is a major public health problem as it represents the main pathologic substrate in ACS, stroke, and peripheral arterial disease. Because of the importance of platelets’ involvement in the initiation and propagation of thrombosis and their contribution in all phases of atherosclerosis, antiplatelet therapy (APT) have come to the forefront of atherothrombotic disease treatment. After the treatment of acute thrombotic episode, long term therapy is warranted as a secondary prophylaxis of such events and their complications. Aspirin is the foundation antiplatelet therapy for patients at risk of cardiovascular events and clopidogrel is an alternative in those cannot tolerate aspirin. Dual antiplatelet therapy (the combination of aspirin and clopidogrel) is superior to antiplatelet monotherapy (aspirin alone or clopidogrel alone) in the setting of percutaneous coronary intervention (PCI) and with stent implantation to prevent stent thrombosis & recurrent ischemic events. However, the benefit from antiplatelet therapy comes at the expense of increased gastrointestinal complications like dyspepsia, nausea, vomiting, abdominal pain and heartburn which impair the quality of life and interfere with patients’ compliance leading to discontinuation of antiplatelet therapy affecting the prognosis of the medical condition.