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Cardiogastroenterology: Management of Elderly Cardiac Patients at Risk of GIB

  • Geriatrics (S Katz & A Afzali, Section Editors)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

To characterize cardiac patients at greatest risk of antithrombotic-related gastrointestinal bleeding (GIB), clarify modifiable risk factors, and summarize best-practice preventive management strategies based on patient characteristics.

Recent findings

Recent study findings reinforce risk factors in this patient cohort, including advanced age and a history of bleeding events. Data also highlight the importance of managing polypharmacy, renal impairment, and eradication of Helicobacter pylori, as well as the utilization of proton pump inhibitors (PPI) for gastroprotection.

Summary

This narrative review will provide up-to-date best practice recommendations to guide clinicians in the management of antithrombotic drugs in elderly cardiac patients and in the prevention of antithrombotic-related GIB.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Acknowledgements

Dr. Abraham and Ms. Huynh are the authors of this manuscript.

Funding

This research was funded by grant R01HS025-402 (Dr. Abraham) from the Agency for Healthcare Research and Quality.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA

    Kimberly Huynh BS & Neena S. Abraham MD, MSCE, FACG, FASGE, AGAF

  2. Department of Health Services Research, Rochester, MN, USA

    Neena S. Abraham MD, MSCE, FACG, FASGE, AGAF

Authors
  1. Kimberly Huynh BS
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  2. Neena S. Abraham MD, MSCE, FACG, FASGE, AGAF
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Corresponding author

Correspondence to Neena S. Abraham MD, MSCE, FACG, FASGE, AGAF .

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Conflict of Interest

Neena Abraham declares no conflict of interest and Kimberly Huynh declares no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Key points

• Patient characteristics including advanced age and history of bleeding are associated with an increased risk of antithrombotic-related GIB.

• Appropriately managing polypharmacy and concomitant prescription of antithrombotic agents decreases the risk of major bleeding events and mortality.

• Utilizing PPI in patients at increased risk for upper GIB greatly decreases the risk of future bleeding events.

• Identification and successful eradication of H. pylori within 3 months of upper GIB are associated with decreased incidence of future UGIB.

• Routine monitoring of renal function in DOAC-treated patients is necessary for identifying individuals who would benefit from dose reduction to prevent excess DOAC plasma levels and decrease the risk of adverse events.

This article is part of the Topical Collection on Geriatrics

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Huynh, K., Abraham, N.S. Cardiogastroenterology: Management of Elderly Cardiac Patients at Risk of GIB. Curr Treat Options Gastro 19, 573–582 (2021). https://doi.org/10.1007/s11938-021-00361-y

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