Safety of antithrombotic therapy in cardiac patients: focus on rebamipid

Patients with coronary artery disease need long-term antiplatelet therapy, and many of them have indications for dual antithrombotic therapy (combination of two antiplatelet agents or the antiplatelet agent and anticoagulant), during which the risk of gastrointestinal bleeding (GIB) increases more, than during antiplatelet monotherapy. Due to the fact that GIB significantly worsens the patient’s prognosis, since it increases the risk of thrombotic complications and fatality, prevention of GIB is of paramount importance. The proton pump inhibitors (PPI) conventionally prescribed for that purpose are not effective enough, and the long-term use of PPI is associated with the emergence of a number of adverse effects, among which the increase in the risk of cardiovascular events and fatality is reported. Furthermore, PPI are not only capable of preventing the erosive and ulcerative lesions of the lower gastrointestinal tract (GIT), but also capable of causing intestinal hemorrhage. In this regard, it is reasonable to use rebamipide, the drug combining gastroprotective and enteroprotective properties, to protect the mucous membrane along the entire length of the GIT. Rebamipide was studied in multiple trials (including randomized controlled trials), which confirmed its efficacy for both treatment and prevention of gastropathy and enteropathy associated with the use of antiplatelet agents (including dual antithrombotic therapy) and non-steroidal anti-inflammatory drugs. The paper reports one of such studies that has been published recently (mostly in 2024).