College of Cardiology Foundation (ACCF), the American College of Gastroenterology (ACG), and the American Heart Association (AHA in a joint document released on Wednesday have asserted that a combination of proton pump inhibitors (PPIs) and anti-platelet drugs is suitable for treating cardiovascular patients with a high risk of upper gastrointestinal (GI) bleeds. This statement came despite recent reports about an adverse reaction between these two types of drugs.

The anti-platelet therapy in patients with atherosclerotic cardio vascular disease showed potential benefits, especially among high risk patients. However, use of anti-platelet drugs increases the risk of gastrointestinal bleeding from pre-existing ulcers, lesions and other tissue breaks in the tract.

According to the new document, "PPIs are prescribed together with anti-platelet drugs for one reason--to reduce the increased risk of GI complications caused by anti-platelet drugs". PPIs help suppress the gastric acid production and hence help heal the pre-existing lesions and ulcers caused by NSAID- and aspirin.

Neena S. Abraham, M.D., MSCE, FACG, a gastroenterologist at the Michael E. DeBakey VAMC and Baylor College of Medicine, the chair of the document's writing committee said, “Our goal was to carefully evaluate recent studies that suggested a potential dangerous interaction between PPIs and thienopyridines, in order to provide clinicians with a pragmatic evidence-based approach for safer prescribing of anti-platelet drugs, especially among patients in whom the risk-benefit ratio requires a careful assessment".

"The document summarizes the best evidence and incorporates the expert clinical viewpoints of both cardiologists and gastroenterologists, who face this dilemma on a daily basis," she added.

“The flurry of conflicting data published following the 2008 Expert Consensus Document left many practitioners confused. However, much of the published data used results of platelet function tests as surrogate markers of cardiovascular risk. The differences in drug levels and in platelet function studies caused concern about an adverse drug interaction, but the clinical significance of these laboratory test results has not been substantiated when held to the higher scientific standard of large patient studies with clinically relevant endpoints, such as heart attacks or strokes," she said.