Geno J. Merli, MD; Howard H. Weitz, MD
Disclosures: Geno J. Merli, MD, reports the following: Research grants/contracts: Bristol-Myers Squibb, Janssen, Portola; Consultancies: Bristol-Myers Squibb, Janssen. Howard H. Weitz, MD, reports that he has no financial relationships or interests to disclose.
Merli G., Weitz H.; Anticoagulation? Antiplatelet? What's the Score?. Ann Intern Med. 2015;163:243. doi: 10.7326/L15-5119-2
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Published: Ann Intern Med. 2015;163(3):243.
The only evidence to guide us on PPI use in the setting of triple-antithrombotic therapy (a vitamin K antagonist, acetylsalicylic acid, and a platelet adenosine diphosphate receptor inhibitor) is level C (consensus). We follow the recommendations of the 2014 American Heart Association/American College of Cardiology Guideline for the Management of Patients with Non–ST-Elevation Acute Coronary Syndromes (1), which recommends PPI use in patients receiving triple antithrombotic therapy who have a history of gastrointestinal bleeding (class I recommendation). For patients without a history of gastrointestinal bleeding, PPI use is suggested; however, the recommendation is weaker (class IIa recommendation).
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