Safety issues of antiplatelet and anticoagulant therapy in cardiological practice


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Abstract

The use of antiplatelet agents and anticoagulants in cardiological practice is associated with an increased risk of developing erosive and ulcerative lesions of the mucous membrane of the gastrointestinal tract (GIT) and the risk of gastrointestinal bleeding. Since antithrombotic drugs are usually prescribed for a long period of time, it is critical to ensure adequate protection of the gastrointestinal mucosa from their damaging effects to increase the safety of treatment. For this purpose, proton pump inhibitors (PPIs) are usually prescribed, but long-term use of PPIs is often accompanied by the development of side effects and is associated with an increased risk of death. In addition, PPIs not only fail to protect the intestinal mucosa from the damaging effects of antithrombotic drugs, but can also provoke bleeding from the lower gastrointestinal tract. In this regard, it seems reasonable to use gastroprotectors that have a mechanism of action different from PPIs, for example, rebamipide, a unique drug that combines the properties of a gastro- and enteroprotector. Numerous studies have proven the effectiveness of rebamipide in gastro- and enteropathy associated with the use of antiplatelet agents, incl. dual antiplatelet therapy. There is also evidence of the efficacy of rebamipide for dyspepsia associated with dabigatran. The available evidence base allows to recommend rebamipide for protecting the gastrointestinal mucosa and increasing the safety of treatment in patients taking antiplatelets and anticoagulants for a long time.

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About the authors

N. M Vorobyeva

Pirogov Russian National Research Medical University - SSS “Russian Gerontological Research and Clinical Center"

Email: natalyavorobjeva@mail.ru

O. N Tkacheva

Pirogov Russian National Research Medical University - SSS “Russian Gerontological Research and Clinical Center"

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