Criteria for a high risk patient:
(1) previous gastrointestinal complications
(2) past history of peptic ulcer
(3) older age
(4) concurrent therapy with corticosteroids and/or anticoagulants
(5) high dose NSAID therapy
(6) therapy with multiple NSAIDS
General rules:
(1) Only treat with aspirin and/or NSAIDS if the benefit outweighs the risk.
(2) Consider an alternative agent with lower risk but similar or greater efficacy.
(3) Use the lowest possible dose of the aspirin and/or NSAID for the shortest period of time.
(4) Treat potentially treatable conditions like gastritis with Helicobacter pylori.
(5) It may be necessary to hold the NSAID for several days following acute hemorrhage, but the duration depends on the risk of complications associated with interrupted therapy.
|
Therapeutic Agent
|
Cardiovascular Risk
|
Adjunctive Agent
|
|
aspirin
|
NA
|
PPI
|
|
NSAID
|
high risk
|
PPI or misoprostol
|
|
NSAID; consider use of COX-2 selective agent
|
low risk
|
PPI or misoprostol
|
|
aspirin and NSAID
|
NA
|
PPI
|
