A study by Sibon and Orgogozo17 demonstrated that 4.5% of strokes were related to recent discontinuation of antiplatelet agents but all events occurred between 6 and 10 days after discontinuation of antiplatelet drugs. Since most peptic ulcer rebleeding occurs within the first 3 days of presentation,18,19 resuming antiplatelet agents at 3–5 days after the last dosing is a reasonable strategy in the management of bleeding ulcer patients with high-risk stigmata of recent hemorrhage (Fig. 1).20 However, patients with low-risk stigmata of recent hemorrhage or clean-base ulcers can keep taking antiplatelet agents immediately

following LBH589 clinical trial endoscopy.21 It merits noting that stent thrombosis is a life-threatening complication of coronary artery stent implantation. Dual antiplatelet therapy with aspirin and clopidogrel is recommended for at least 12 months after drug-eluting stent implantation compared with 4 weeks after placement of bare-metal stent.22 Discontinuation of antiplatelet therapy (particularly clopidogrel) is a crucial independent factor for the development of stent thrombosis. A recent study showed that the incidence of major cardiovascular

events was significantly higher if dual antiplatelet therapy was discontinued within one month of bare-metal stent, 3 months of Sirolmus drug-eluting stent and 6 months of Paclitaxel drug-eluting stent placement.23 Because the risk of stent thrombosis with removal of antiplatelet agents is high within the critical 上海皓元医药股份有限公司 periods following A-769662 percutaneous coronary intervention,

and antiplatelet effects of aspirin and clopidogrel may last at least a few days after cessation, resuming antiplatelet therapy at 3 days after the last dosing is recommended for the bleeding ulcer patients undergoing recent coronary stenting (Fig. 1). Currently, the best initial treatment of low-dose aspirin-related peptic ulcer remains unclear. Although the discontinuation of aspirin use during the period of ulcer healing may avoid further GI injury, the withdrawal of the antiplatelet agent could potentially precipitate an ischemic vascular event, particularly in high-risk patients with acute coronary syndrome. In contrast, continued use of aspirin may prevent CV events but the antiplatelet agent could potentially hinder ulcer healing and precipitate bleeding in ulcer patients. As mentioned in the previous section, the initial step in reducing GI risk of antiplatelet therapies is to assess whether the patient has a continued need of antiplatelet therapy (Fig. 2). Depending on the indication for antiplatelet therapy, some patients may be able to withdraw antiplatelet agents after consultation with cardiologists or neurologists.