Key result
P-CAB use was associated with a reduced risk of UGI bleeding compared to no P-CAB/PPI (HR 0.59; 95% CI 0.38-0.92; p=0.019), with no significant difference compared to PPI users.
Why the study?
Although PPIs are the drug of choice to prevent UGI bleeding in patients on DAPT, unmet needs remain, and P-CABs have emerged as potential alternatives.
Do potassium-competitive acid blockers reduce upper gastrointestinal bleeding compared to proton pump inhibitors or no therapy in patients on dual antiplatelet therapy after percutaneous coronary intervention?
Cohort (n=210,447)
Yes
Do potassium-competitive acid blockers reduce upper gastrointestinal bleeding compared to proton pump inhibitors or no therapy in patients on dual antiplatelet therapy after percutaneous coronary intervention?
Hazard Ratio: 0.59 (95% CI 0.38–0.92)
p-value: p=0.019
In patients on dual antiplatelet therapy after PCI, potassium-competitive acid blockers reduce the risk of upper gastrointestinal bleeding comparably to proton pump inhibitors, offering a viable alternative for gastroprotection.
P-CABs were associated with lower UGI bleeding versus no suppression in post-PCI DAPT; leaves open equivalence to PPIs.
BACKGROUND AND AIM: Proton pump inhibitors (PPIs) are the drug of choice to prevent upper gastrointestinal (UGI) bleeding in patients receiving dual antiplatelet therapy (DAPT); however, unmet needs remain. Potassium-competitive acid blockers (P-CABs) are novel acid-suppressive drugs that have emerged as potential alternatives. We evaluated the effectiveness of P-CAB in reducing the risk of UGI bleeding in patients receiving DAPT after percutaneous coronary intervention (PCI). METHODS: This retrospective cohort study included patients with PCI on DAPT between January 2019 and January 2023 using the Korean nationwide health claims database. The primary outcome was admission for UGI bleeding within 6 months of PCI. A multivariate Cox regression model was used to evaluate UGI bleeding risk based on PPIs and P-CAB use. RESULTS: Of the 210 447 patients who underwent PCI on DAPT (mean age, 65.5 years; 74.7% men), 4.6% and 47.5% patients were prescribed P-CABs and PPIs, respectively. Overall, 0.3% of patients experienced UGI bleeding within 6 months of PCI. P-CAB users had a reduced risk of UGI bleeding (adjusted hazard ratio, 0.59; 95% confidence interval, 0.38-0.92; p = 0.019) compared with patients not receiving P-CAB or PPI. No significant difference was observed between the P-CAB and PPI users (p > 0.05). CONCLUSIONS: Among Korean patients undergoing PCI with DAPT, P-CABs reduced UGI bleeding comparably to PPIs. These findings suggest that P-CABs are potential alternatives to PPIs for preventing UGI bleeding.
No takes yet. Share an insight, caveat, or question.
Baik et al. (2025) conducted a cohort in Patients on dual antiplatelet therapy after percutaneous coronary intervention (n=210,447). Potassium-competitive acid blockers (P-CABs) vs. Patients not receiving P-CAB or PPI was evaluated on Admission for UGI bleeding within 6 months of PCI (HR 0.59, 95% CI 0.38-0.92, p=0.019). P-CAB use was associated with a reduced risk of UGI bleeding compared to no P-CAB/PPI (HR 0.59; 95% CI 0.38-0.92; p=0.019), with no significant difference compared to PPI users.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: