Pharmaceutical and clinical implications of proton pump inhibitors with dual antiplatelet therapies: a systematic review

Proton pump inhibitors (PPIs) are frequently co-prescribed with dual antiplatelet therapy (DAPT) agents to mitigate the potential of increased gastrointestinal bleeding associated with antiplatelet therapy. Experimental studies have suggested that certain PPIs, such as omeprazole and esomeprazole, may decrease the antiplatelet effects of P2Y12 inhibitors, especially clopidogrel, and, therefore, may potentiate adverse cardiovascular and cerebrovascular events. Data from randomized controlled trials and observational studies have produced mixed results on the clinical implications of this theory. This comprehensive narrative review aims to provide an in-depth analysis of the interactions between PPIs and dual antiplatelet agents, shedding light on their mechanisms and clinical implications and identifying areas for therapeutic optimization. We also address recent advancements in personalized medicine and the potential role of genetic factors in influencing individual responses to PPIs and antiplatelet drugs to optimize treatment outcomes and minimize adverse effects.