Doctors' Groups Collaborate on Care for Heart Patients

THURSDAY Oct. 9, 2008 -- Three leading medical associations have created guidelines to help heart disease patients cut their risk of ulcers and gastrointestinal bleeding from one the condition's most common treatments -- antiplatelets and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin.

The American College of Cardiology, the American College of Gastroenterology and the American Heart Association guidelines call on doctors to better assess the patient's risk factors before treatment starts. These include considering:

  • age,
  • previous history of ulcers or bleeding,
  • presence of H. pylori (a common bacteria that contributes to the development of stomach ulcers), and,
  • acid reflux symptoms.

Doctors are also advised to review the patient's use of other NSAIDs, anticoagulants and/or corticosteroids.

Having several of these risk factors greatly increases the person's chance of gastrointestinal bleeding, a major and potentially life-threatening complication.

"These recommendations represent the collective expertise of leading cardiologists and gastroenterologists, as well as an extensive review of the literature, and provide specialists with practical measures to manage competing risks and help improve patient safety," Dr. Deepak L. Bhatt, document co-chair and chief of cardiology at the VA Boston Healthcare System, said in a news release.

Antiplatelets, which reduce the blood's ability to clot, are key to preventing a cardiovascular event in people with atherosclerotic disease. The treatment is usually prescribed with daily low-dose aspirin, a NSAID.

NSAIDs, one of the most widely used classes of drugs in the United States, help reduce fever, pain and inflammation. These drugs -- which include aspirin, ibuprofen, ketoprofen and naproxen -- are often used to treat other common conditions, including arthritis, inflammation and related musculoskeletal pain.

People on low-dose aspirin plus NSAIDs have a two- to fourfold increased risk of gastrointestinal bleeding compared with those not taking these medications, the specialists said.

"The recommendations will help physicians evaluate the risk profile for each patient and either change medications or provide appropriate therapies to help reduce GI complications," Dr. Elliott Antman, a member of the writing group and a professor of medicine at Harvard Medical School, said in the same news release.

"We must be more proactive in assessing individual patient risk to be able to prevent gastrointestinal problems as antiplatelet therapy is actually initiated," Dr. David A. Johnson, immediate past president of the American College of Gastroenterology, said in the same news release. "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."

As more Americans survive and live with heart disease, in addition to conditions such as arthritis and related musculoskeletal pain that require them to take NSAIDs, managing gastrointestinal risk will become an increasingly important part of cardiovascular care, the doctors said.

Posted: October 2008


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