Atherosclerosis, plaque rupture, and thrombosis are the direct causes of cardiovascular and cerebrovascular events, and thrombotic disease has become the number one killer of human health. Antiplatelet therapy is one of the main tools to prevent thrombotic disease, but many clinicians are choking on the fear that antiplatelet drugs will increase the risk of gastrointestinal bleeding and intracranial hemorrhage. The expert consensus published jointly by the American College of Cardiology Foundation (ACCF), the American College of Gastroenterology (ACG) and the American Heart Association (AHA) in 2008 provides new insights from a multidisciplinary perspective on antiplatelet therapy for patients with risk factors for recurrent peptic ulcers. Highlights1 Previous authoritative guidelines from the ACC and the European Society of Cardiology (ESC) have recommended clopidogrel replacement for patients with contraindications to aspirin (ASA). This expert consensus suggests that instead of clopidogrel as a substitute for ASA in patients at high risk of recurrent peptic ulcer, ASA combined with a proton pump inhibitor (PPI) is recommended, a complete reversal of the previous management approach. The expert consensus questioned the results of the previous safety rationale for clopidogrel as an alternative to ASA, mainly from the CAPRIE study: firstly, clopidogrel at a conventional dose of 75 mg/d and ASA at a high dose of 325 mg/d; secondly, at a mean follow-up of 1.91 years, the number of patients with severe gastrointestinal bleeding was higher in the ASA group than in the clopidogrel group, but the difference was only 0.2%. Prior to the publication of the consensus, a prospective study was conducted on the use of clopidogrel or ASA combined with PPI in patients at high risk of peptic ulcer. 320 patients were included and randomized to the ASA combined with PPI and clopidogrel groups, and the mean follow-up of 12 months found that recurrence of upper gastrointestinal bleeding was significantly less in the ASA combined with PPI group than in the clopidogrel group (0.7% vs. 8.6% , P=0.001). Highlight 2 The expert consensus recommends PPI as a treatment and prophylaxis for ASA or non-steroidal anti-inflammatory drug (NSAID)-induced GI injury and has developed a flow chart to reduce the incidence of GI bleeding in this regard. Highlight 3 The expert consensus recommends that whether and when to discontinue antiplatelet therapy in patients with high-risk coronary artery disease requiring gastrointestinal endoscopy should be determined by specialists in both cardiology and gastrointestinal endoscopy after weighing the risks of bleeding and thrombotic events. In conclusion ASA is the cornerstone of long-term antithrombotic therapy in patients with cardiovascular disease, including both primary and secondary prevention. the rate of fatal GI injury from ASA is low, with an average of l cases of vomiting per 5000 patients treated with ASA, and ASA reduces the number of serious cardiovascular and cerebrovascular events by 19 per year for every 1000 patients treated. Therefore, long-term antiplatelet therapy should be adhered to in patients with indications, while taking appropriate measures to avoid and reduce the occurrence of GI injuries. Even small doses of ASA can lead to GI injury, and the optimal dose of ASA for long-term use is 75 mg/d~100 mg/d. The difference in the risk of peptic ulcer and GI bleeding with different doses of ASA is not statistically significant. High-risk groups: >65 years old, history of peptic ulcer or bleeding, combined Hp infection, combined antiplatelet therapy or anticoagulation, or combined treatment with NSAIDs or glucocorticoid drugs. Hp screening and eradication should be performed in high-risk groups who have been taking antiplatelet drugs for a long time, and can be prevented and treated with a combination of PPI or mucosal protective agents. Whether to discontinue antiplatelet agents after the occurrence of GI injury needs to be balanced with the patient’s risk of thrombosis and bleeding. Clopidogrel is not recommended to replace ASA therapy in patients with ASA-induced ulcers and bleeding, and it is recommended to give ASA combined with PPI therapy. Both clinicians and patients need to monitor GI injury caused by long-term antiplatelet therapy, pay attention to the presence of black stools, and perform regular fecal occult blood tests.