Key result
Concurrent PPI use with DAPT in post-PCI patients significantly increased the risk of MACE (OR 1.12; 95% CI 1.04-1.21) while reducing GI events (OR 0.75; 95% CI 0.68-0.83).
Why the study?
PPIs are co-prescribed to reduce GI bleeding with DAPT after PCI, but concerns persist that interactions with P2Y12 inhibitors may compromise cardiovascular outcomes.
Does concurrent proton pump inhibitor use alter cardiovascular outcomes or provide gastrointestinal protection in patients receiving dual antiplatelet therapy post-PCI?
Meta-Analysis
Does concurrent proton pump inhibitor use alter cardiovascular outcomes or provide gastrointestinal protection in patients receiving dual antiplatelet therapy post-PCI?
Odds Ratio: 1.12 (95% CI 1.04–1.21)
While PPIs offer substantial gastrointestinal protection in patients on DAPT post-PCI, their concomitant use may elevate cardiovascular risk, particularly with clopidogrel and long-term therapy.
PPI co-prescription may increase MACE risk despite GI protection in DAPT patients; leaves open optimal risk-benefit balance pending RCTs.
Background: Dual antiplatelet therapy (DAPT) is a standard treatment following percutaneous coronary intervention (PCI), significantly reducing ischemic events but increasing gastrointestinal (GI) bleeding risk. Proton pump inhibitors (PPIs) are frequently co-prescribed to mitigate this risk, yet concerns persist regarding potential interactions with P2Y12 inhibitors—particularly clopidogrel—that may compromise cardiovascular outcomes. Objective: The objective of this meta-analysis is to assess the impact of proton pump inhibitor (PPI) use on the efficacy and safety of dual antiplatelet therapy (DAPT) in patients who have undergone percutaneous coronary intervention (PCI). By analyzing data from randomized controlled trials (RCTs), this study aims to determine whether concurrent PPI therapy alters cardiovascular outcomes or provides gastrointestinal protection without compromising antiplatelet effectiveness. Methods: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science identified RCTs comparing DAPT with and without concurrent PPI use in PCI patients. Five RCTs met the inclusion criteria. Primary outcomes included major adverse cardiovascular events (MACE), myocardial infarction (MI), stroke, and GI events. Data were synthesized using a random-effects model, and heterogeneity was assessed via the I² statistic. Results: PPI use was associated with a significantly increased risk of MACE (OR: 1.12; 95% CI: 1.04–1.21), MI (OR: 1.20; 95% CI: 1.10–1.31), and stroke (OR: 1.15; 95% CI: 1.02–1.29), while significantly reducing GI events (OR: 0.75; 95% CI: 0.68–0.83). Subgroup analyses indicated heightened cardiovascular risk in high-risk patients and those on prolonged DAPT or omeprazole. Heterogeneity was low to moderate across outcomes. Conclusion: While PPIs offer substantial GI protection in patients on DAPT post-PCI, their use may elevate cardiovascular risk, particularly with clopidogrel and long-term therapy. These findings support personalized risk-benefit assessment and the cautious selection of PPIs in this patient population.
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Shadia et al. (2025) conducted a meta-analysis in Post-PCI patients on dual antiplatelet therapy. Proton pump inhibitors (PPIs) vs. DAPT without concurrent PPI use was evaluated on Major adverse cardiovascular events (MACE) (OR 1.12, 95% CI 1.04-1.21). Concurrent PPI use with DAPT in post-PCI patients significantly increased the risk of MACE (OR 1.12; 95% CI 1.04-1.21) while reducing GI events (OR 0.75; 95% CI 0.68-0.83).
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