Temporal trends in use of antisecretory agents among patients administered clopidogrel- based dual antiplatelet therapy after percutaneous coronary intervention

Abstract Background: Antisecretory drugs are commonly prescribed with clopidogrel-based dual antiplatelet therapy (DAPT) to prevent gastrointestinal bleeding in high-risk patients after percutaneous coronary intervention (PCI). However, omeprazole and esomeprazole (inhibiting proton pump inhibitors [PPIs]) increase cardiovascular event rates on co-administration with clopidogrel. This study aimed to examine trends in the use of antisecretory agents in patients administered clopidogrel-based DAPT and the concomitant use of clopidogrel and inhibiting PPIs. Methods: We used National Inpatient Sample data compiled by the Health Insurance Review & Assessment Service from 2009 to 2020. Further, we identified patients who were prescribed clopidogrel-based DAPT after PCI and investigated the concomitant use of antisecretory agents with clopidogrel. To verify the annual trend of drug utilization, we used the Cochran–Armitage trend test. Results: From 2009 to 2020, the percentage of H2 receptor antagonists users decreased steadily (from 82.5 % in 2009 to 25.3 % in 2020); instead, the percentage of PPI users increased (from 34.7 % in 2009 to 69.0 % in 2020). The use of inhibiting PPI also increased (from 4.2 % in 2009 to 30.7 % in 2020). P-CAB was rarely used before 2019; however, in 2020, it accounted for 7.8 % of the antisecretory users. Conclusions: Our study demonstrates that the use of inhibiting PPIs increased steadily in patients administered clopidogrel-based DAPT therapy. This is a major concern since the concomitant use of inhibiting PPIs with clopidogrel could increase the risk of cardiovascular events.