New guidelines: Multidisciplinary communication key to reduce GI bleeding

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The American College of Cardiology (ACC), in collaboration with the American College of Gastroenterology (ACG) and the American Heart Association (AHA), has released consensus guidelines outlining an appropriate approach for reducing the risk of ulcers and gastrointestinal (GI) bleeding among patients using nonsteroidal anti-inflammatory drugs, along with antiplatelet agents.

GI bleeding is a major and potentially life-threatening complication for patients taking antiplatelet and nonsteroidal anti-inflammatory drugs (NSAID) therapy, according to Deepak L. Bhatt, MD, document co-chair and chief of cardiology at the Veterans Affairs Boston Healthcare System. Patients taking low-dose aspirin, plus NSAIDs, have a two- to four-fold increased risk of GI bleeding, compared with those not taking the medications.  

“Communication among cardiologists, gastroenterologists and primary care physicians is critical. At the same time, patients must tell their doctors about any and all medications they are taking—prescription and over-the-counter medicines—so appropriate measures can be taken to reduce risk,” said David A. Johnson, MD, immediate past president of the ACG and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Va.

According to a recent survey, 18 percent of patients failed to report recent use of non-prescription NSAIDs, which greatly complicates attempts to manage risk. Since GI problems may arise with few, if any, symptoms (e.g., blood in stool, fatigue, abdominal pain), ongoing monitoring is also important.
To reduce problems, providers must assess individual patient risk factors for possible GI complications, including age, previous history of ulcers or bleeding, presence of H. pylori, dyspepsia symptoms, as well as the simultaneous use of NSAIDs, anticoagulants and/or corticosteroids. The presence of several risk factors further increases the possibility of bleeding, according to the guidelines.
The recommendations are part of an ongoing dialogue between the three collaborating organizations and, according to the authors, will be updated as more definitive data are accrued.  The document was developed by the ACC Foundation Task Force on Expert Consensus Documents, which helps guide clinical practice in areas where evidence may not be available or the evidence to date is not widely accepted.