The most important adverse effect of antiplatelet and anticoagulant therapy
is the occurrence of bleeding. Gastroenterologists, cardiologists, and primary care
physicians often find themselves balancing the benefits of antiplatelet and
anticoagulant therapy with the risk of bleeding, namely gastrointestinal bleeding. While
aspirin and warfarin have long been the mainstay of oral antiplatelet and anticoagulant
therapy, respectively, recent discoveries of more precise targets for therapy have come
to market in order to reduce the risk of cardiovascular events and overcome the wellknown
limitations that plague warfarin therapy (e.g. narrow therapeutic index, variable
individual metabolic response, and numerous food and drug interactions). Despite the
fact that these novel agents may increase the risk of gastrointestinal bleeding [1], their
ease of use makes them more attractive than conventional agents. This review will
provide an overview of the pharmacology of available antiplatelet agents and
anticoagulants, outline risks that clinicians should be cognizant of when considering
prophylactic therapy in order to reduce the risk of gastrointestinal toxicity, and provide
up to date data on reversal agents that are currently available as well as those that are in
the pipeline.
