Role of Proton Pump Inhibitors in Cardiac Patients: Guideline Recommendations Versus Practical Approach

Dual-antiplatelet therapy (DAPT) is a cornerstone treatment for patients diagnosed with acute coronary syndrome (ACS) and coronary artery disease (CAD). Although DAPT effectively reduces the occurrence of thrombotic events, it also substantially increases the likelihood of gastrointestinal (GI) bleeding. Proton pump inhibitors (PPIs) are essential for mitigating the GI bleeding risk, yet concerns persist regarding their prolonged use and potential adverse effects. Apart from rabeprazole, PPIs share the hepatic metabolism pathway with clopidogrel, resulting in unfavorable cardiovascular outcomes. The pairing of rabeprazole with clopidogrel emerges as a prudent recommendation, displaying superior efficacy in mitigating major adverse cardiovascular events (MACE) when juxtaposed with other PPIs. This narrative review underscores the complexity of managing PPIs in cardiac patients and emphasizes the importance of tailored approaches based on emerging evidence while providing valuable insights to clinicians navigating this challenging therapeutic landscape.