Risk management of risk management: Combining proton pump inhibitors with low-dose aspirin

Abstract

Harald Vonkeman, Inger Meek, Mart van de LaarDepartment of Rheumatology and Clinical Immunology, Arthritis Centre Twente, Medisch Spectrum Twente and University of Twente, Enschede, The NetherlandsAbstract: Low-dose aspirin is widely used in the primary and secondary prevention of cardiovascular events, but is associated with a range of upper gastrointestinal side effects. In this review, we summarize the rationale for low-dose aspirin therapy, quantify the risk for upper gastrointestinal side effects, identify the risk factors involved, and provide an overview of preventive strategies, thereby focusing on the rationale and clinical utility of combining proton-pump inhibitors with low-dose aspirin.Keywords: low-dose aspirin, gastrointestinal ulcers, Helicobacter pylori, proton-pump inhibitors, H2-receptor antagonists, clopidogrel