There is increased risk of bleeding due anti platelet therapy. Prophylactic gastro protection is recommended in patients with history of ulcers and bleeds.
This consensus document published by ACC/ACG. The recommendations made in the document:
- All NSAIDs, including COX-2 inhibitors, raise the risk of GI ulcers and bleeding when combined with ASA taken chronically for cardioprotection.
- Even on its own, chronic ASA for cardioprotection increases the risk of upper-GI events and should generally be limited to 81 mg/day.
- Patients at increased GI bleeding risk should go on a PPI; those with a history of ulcers should be evaluated and, as appropriate, treated for Helicobacter pylori infection before starting antiplatelet therapy.
- Substituting clopidogrel for ASA doesn't cut the risk of GI bleeding and isn't as effective as the combination of ASA and a PPI.
- PPIs such as lansoprazole and omeprazole are preferred over misoprostol, sucralfate, or histamine 2 (H2)-receptor antagonists for both the prevention and treatment of gastroduodenal lesions associated with ASA and other NSAIDs.
- "Communication between cardiologists, gastroenterologists, and primary-care physicians is critical to weigh the ischemic and bleeding risks in an individual patient who needs antiplatelet therapy but who is at risk for or develops significant GI bleeding."
