Key result
Co-prescription of proton pump inhibitors with dual-antiplatelet therapy reduces the risk of upper gastrointestinal bleeding without significantly increasing adverse cardiovascular events.
Why the study?
When initiating DAPT, the risk of thrombosis must be balanced with increased upper gastrointestinal bleeding risk, warranting a review of the benefits and complications of concurrent PPI therapy.
Does the co-prescription of proton-pump inhibitors with dual-antiplatelet therapy reduce the risk of upper gastrointestinal bleeding in patients with coronary artery disease?
Does the co-prescription of proton-pump inhibitors with dual-antiplatelet therapy reduce the risk of upper gastrointestinal bleeding in patients with coronary artery disease?
Co-prescription of PPIs with DAPT is a safe and effective strategy to reduce upper gastrointestinal bleeding risk, though long-term data are still needed.
Answers are grounded in this paper and cite their sources.
May support PPI co-prescription with DAPT to lower GI bleeding; leaves open need for long-term RCTs.
Dual-antiplatelet therapy (DAPT) prevents thrombotic complications associated with coronary artery disease, acute coronary syndrome, and stent thrombosis following the percutaneous coronary intervention or coronary artery bypass grafting. When initiating DAPT, the risk of thrombosis must be balanced with the increased risk of upper gastrointestinal bleed (UGIB). Proton-pump inhibitors (PPIs) are concurrently prescribed with DAPT to reduce bleeding risk. In this review, we discuss the benefits and potential complications of DAPT/PPI co-prescription. The only large international randomized control trial (RCT), Clopidogrel and the Optimization of Gastrointestinal Events Trial (COGENT), shows robust evidence that PPIs are a safe and effective method to reduce the risk of bleeding in patients on DAPT. However, more large-scale RCTs are needed to study potential long-term effects and draw a stronger conclusion on this topic.
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Saven et al. (2022) conducted a review in Coronary artery disease and acute coronary syndrome requiring DAPT. Proton Pump Inhibitors (PPIs) with Dual-Antiplatelet Therapy (DAPT) vs. DAPT without PPIs was evaluated. Co-prescription of proton pump inhibitors with dual-antiplatelet therapy reduces the risk of upper gastrointestinal bleeding without significantly increasing adverse cardiovascular events.
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