Proton pump inhibitor therapy was associated with a reduced risk of upper gastrointestinal bleeding compared to no therapy in patients on DAPT after MI (RR 0.62; 95% CI 0.48-0.77).
Cohort (n=46,301)
Yes
Does proton pump inhibitor therapy reduce upper gastrointestinal bleeding in patients treated with dual antiplatelet therapy after myocardial infarction?
Proton pump inhibitor therapy is associated with a reduced risk of upper gastrointestinal bleeding in patients on DAPT after MI, though it remains underutilized in high-risk patients according to current guidelines.
Relative Risk: 0.62 (95% CI 0.48–0.77)
Absolute Risk Reduction: 0.44%
AIMS: Guidelines differ in their recommendations on therapy to prevent gastrointestinal bleeding for patients treated with dual antiplatelet treatment (DAPT). We sought to investigate the effectiveness of proton pump inhibitors (PPIs) to prevent upper gastrointestinal (UGI) bleeding in patients using DAPT following myocardial infarction (MI) in relation to current European Society of Cardiology guidelines recommendations. METHODS AND RESULTS: We linked Danish nationwide registries to identify patients taking DAPT 7 days following hospital discharge for an acute MI, and excluded individuals on anticoagulation therapy. We used multiple Cox regression modelling, to compute average risk of UGI bleeding in relation to PPI use. The associated treatment efficacy was compared based on guideline risk assessment. We studied 46 301 patients on DAPT after MI. Only 35% of patients at higher risk of UGI bleeding received recommended treatment with a PPI based on the guideline criteria. The 1--year risk of UGI bleeding was 1.0% 95% confidence interval (CI) 0.9-1.1% and 1.7% (CI 1.5-2.0%) for high-risk patients. Overall PPI compared with no therapy, was associated with a risk ratio for UGI bleeding of 0.62 (CI 0.48-0.77) corresponding to an absolute risk difference of 0.44% (CI 0.39-0.48%). Proton pump inhibitor therapy was associated with a similar absolute risk difference 0.47% (CI 0.43-0.51%) for high-risk patients. CONCLUSION: Proton pump inhibitor therapy is used less than suggested by guidelines in patients treated with DAPT following MI and was generally associated with reduced risk of UGI bleeding. Considering the overall low risk of bleeding, more focus should be on identifying patients benefiting the most from PPI therapy.
Sehested et al. (Mon,) conducted a cohort in myocardial infarction (n=46,301). Proton pump inhibitors vs. no therapy was evaluated on upper gastrointestinal (UGI) bleeding (RR 0.62, 95% CI 0.48-0.77). Proton pump inhibitor therapy was associated with a reduced risk of upper gastrointestinal bleeding compared to no therapy in patients on DAPT after MI (RR 0.62; 95% CI 0.48-0.77).