Aspirin is widely used for the prevention of thrombotic cardiovascular disease. The effect of platelet antiaggregation is achieved with low doses of 75-325 mg/day. Due to COX-1 inhibition, associated gastrointestinal adverse effects can occur. Other drugs whose platelet antiaggregant effect is achieved through different mechanisms of action have been developed, such as clopidogrel and ticlopidine, which do not inhibit COX-1. The proportion of patients taking low-dose aspirin alone or in combination with other antiaggregants is high and consequently the use of these drugs should be optimized by reducing their gastrointestinal adverse effects to a minimum. Knowledge of the risk factors that increase the risk of gastrointestinal adverse effects with platelet antiaggregants, such as age, concomitant use of other drugs such as anticoagulants or non-steroidal anti-inflammatory drugs, a history of peptic ulcer -whether complicated or uncomplicated-, and Helicobacter pylori infection, would help to allow management to be individually tailored to each patient. The use of proton pump inhibitors and/or H. pylori eradication should allow a positive balance, even in patients with gastrointestinal risk factors.
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