GUIDELINES FOR PREVENTION AND MANAGEMENT OF GASTROINTESTINAL ADVERSE EFFECTS IN PATIENTS RECEIVING NON-STEROIDAL ANTI-INFLAMMATORY AND ANTIAGGREGANT THERAPY

  • Borut Štabuc Klinični oddelek za gastroenterologijo Univerzitetni klinični center Ljubljana Japljeva 2,1000 Ljubljana
  • Bojan Tepeš Abakus Medico Diagnostični center Rogaška Prvomajska 29 A,3250 Rogaška Slatina
  • Pavel Skok Klinični oddelek za gastroenterologijo Univerzitetni klinični center Maribor Ljubljanska 5,2000 Maribor
  • Miroslav Vujasinović Oddelek za interno medicino Splošna bolnišnica Slovenj Gradec Gosposvetska 1,2380 Slovenj Gradec
  • Aleš Blinc Klinični oddelek za žilne bolezni Univerzitetni klinični center Ljubljana Zaloška cesta 7,1000 Ljubljana
  • Miha Čerček Klinični oddelek za kardiologijo Univerzitetni klinični center Ljubljana Zaloška cesta 7,1000 Ljubljana
  • Matija Tomšič Klinični oddelek za revmatologijo Bolnišnica dr. Petra Držaja Univerzitetni klinični center Ljubljana Vodnikova cesta 62,1000 Ljubljana
  • Saša Markovič Klinični oddelek za gastroenterologijo Univerzitetni klinični center Ljubljana Japljeva 2,1000 Ljubljana
Keywords: guidelines, side-effects, nonsteroidal antiinflammatory drugs, antiaggregants, gastrointestinal system, cardiovascular system

Abstract

Adverse effects of nonsteroidal antiinflammatory drugs and antiaggregants on gastrointestinal tract can be prevented or reduced by rational prescribing, use of proton pump inhibitors and Helicobacter pylori eradication.

Nonsteroidal antiinflammatory drugs should not be used to treat patients with high risk for serious adverse effects on either upper gastrointestinal or cardiovascular system. Proton pump inhibitors in standard oral dosages are used for treatment of dyspepsia or gastric and duodenal erosions and ulcers, caused by nonsteroidal antiinflammatory drug or antiaggregant use. Peptic ulcer hemorrhage is treated with endoscopic hemostasis and proton pump inhibitors (72-hour continuous infusion followed by 4 – 8 week standard dose oral treatment).

Patients can be stratified into three groups based on risk for upper gastrointestinal system adverse effects associated with nonsteroidal antiinflammatory drugs or antiaggregants use. Absence of risk factors denotes low-risk patient population, one or two risk factors are associated with medium risk; high-risk patients harbor either three or more risk factors or history of complicated peptic ulcer disease.  Helicobacter pylori should be eradicated (if present) in all medium and high-risk patients prior to introduction of nonsteroidal antiinflammatory drugs or antiaggregants and proton pump inhibitors in standard daily dose should be prescribed for the duration of the treatment.

Risk of gastrointestinal hemorrhage should be considered when planning invasive cardiovascular procedures or introduction of antiaggregant or anticoagulant treatment. In the context of acute gastrointestinal hemorrhage, antiaggregants should not be discontinued for longer than 7 days and oral anticoagulant therapy should be stopped and converted to low-molecular-weight heparin after complete hemostasis.

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Author Biographies

Borut Štabuc, Klinični oddelek za gastroenterologijo Univerzitetni klinični center Ljubljana Japljeva 2,1000 Ljubljana

Prof.dr. Borut Štabuc, dr.med., višji svetnik

Klinični oddelek za gastroenterologijo

Univerzitetni klinični center Ljubljana

Japljeva 2,1000 Ljubljana

Bojan Tepeš, Abakus Medico Diagnostični center Rogaška Prvomajska 29 A,3250 Rogaška Slatina

Prof.dr. Bojan Tepeš, dr.med.

Abakus Medico

Diagnostični center Rogaška

Prvomajska 29 A,3250 Rogaška Slatina

Pavel Skok, Klinični oddelek za gastroenterologijo Univerzitetni klinični center Maribor Ljubljanska 5,2000 Maribor

Prof.dr. Pavel Skok, dr.med.

Klinični oddelek za gastroenterologijo

Univerzitetni klinični center Maribor

Ljubljanska 5,2000 Maribor

Miroslav Vujasinović, Oddelek za interno medicino Splošna bolnišnica Slovenj Gradec Gosposvetska 1,2380 Slovenj Gradec

Asist.mag. Miroslav Vujasinović, dr.med.

Oddelek za interno medicino

Splošna bolnišnica Slovenj Gradec

Gosposvetska 1,2380 Slovenj Gradec

Aleš Blinc, Klinični oddelek za žilne bolezni Univerzitetni klinični center Ljubljana Zaloška cesta 7,1000 Ljubljana

Prof.dr. Aleš Blinc, dr.med.

Klinični oddelek za žilne bolezni

Univerzitetni klinični center Ljubljana

Zaloška cesta 7,1000 Ljubljana

Miha Čerček, Klinični oddelek za kardiologijo Univerzitetni klinični center Ljubljana Zaloška cesta 7,1000 Ljubljana

Asist.dr. Miha Čerček, dr.med.

Klinični oddelek za kardiologijo

Univerzitetni klinični center Ljubljana

Zaloška cesta 7,1000 Ljubljana

Matija Tomšič, Klinični oddelek za revmatologijo Bolnišnica dr. Petra Držaja Univerzitetni klinični center Ljubljana Vodnikova cesta 62,1000 Ljubljana

Prof.dr. Matija Tomšič, dr.med.

Klinični oddelek za revmatologijo

Bolnišnica dr. Petra Držaja

Univerzitetni klinični center Ljubljana

Vodnikova cesta 62,1000 Ljubljana

Saša Markovič, Klinični oddelek za gastroenterologijo Univerzitetni klinični center Ljubljana Japljeva 2,1000 Ljubljana

Prof.dr. Saša Markovič, dr.med., višja svetnica

Klinični oddelek za gastroenterologijo

Univerzitetni klinični center Ljubljana

Japljeva 2,1000 Ljubljana

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Published
2015-02-27
How to Cite
1.
Štabuc B, Tepeš B, Skok P, Vujasinović M, Blinc A, Čerček M, Tomšič M, Markovič S. GUIDELINES FOR PREVENTION AND MANAGEMENT OF GASTROINTESTINAL ADVERSE EFFECTS IN PATIENTS RECEIVING NON-STEROIDAL ANTI-INFLAMMATORY AND ANTIAGGREGANT THERAPY. ZdravVestn [Internet]. 27Feb.2015 [cited 18Jun.2019];84(1). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/1171
Section
Quality and safety