Tegoprazan reduced gastrointestinal bleeding by 28% (HR 0.72) and major bleeding by 31% (HR 0.69) versus PPIs without increasing ischemic events in AMI patients on DAPT.
Does tegoprazan reduce bleeding or ischemic events compared to PPIs in AMI patients receiving DAPT after PCI?
In AMI patients on DAPT after PCI, tegoprazan reduces the risk of gastrointestinal and major bleeding compared to PPIs without increasing ischemic events.
Abstract Background Data on the interactions between P2Y12 inhibitors and tegoprazan are limited. This study compared the effects of tegoprazan and proton-pump inhibitors (PPIs) on clinical outcomes in patients receiving dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for acute myocardial infarction (AMI). Methods Using the nationwide claims-based databases of the National Health Insurance Service (NHIS) from March 2019 to September 2022, we retrospectively analyzed 21,276 patients treated with either tegoprazan (n = 2,075) or PPIs (n = 19,201) combination with DAPT after PCI for AMI. The primary safety outcomes were gastrointestinal bleeding and major bleeding at one year, while the primary effectiveness outcomes included myocardial infarction and stroke. Net adverse clinical evpents (NACE), defined as composite of major bleeding, myocardial infarction and stroke, were also assessed. Results The mean age was 65.2 ± 12.6 years and 75.8% were male. In a propensity-matched cohort, compared with PPIs, tegoprazan was associated with a lower risk of gastrointestinal bleeding (hazard ratio HR 0.72, 95% confidence interval CI 0.54-0.98, P=0.04) and major bleeding (HR 0.69, 95% CI 0.49-0.98, P=0.04), while the risks of myocardial infarction (HR 0.83, 95% CI 0.53-1.31, P=0.43) and stroke (HR 0.95, 95% CI 0.47-1.94, P=0.89) were similar. NACE was lower in the tegoprazan group (HR 0.75, 95% CI 0.58-0.97, P=0.03). Conclusions the use of tegoprazan was associated with a lower risk of bleeding compared with PPIs, without an increased risk of ischemic events in AMI patients receiving DAPT after PCI. Further prospective studies are warranted.
Lee et al. (2025) studied this question. Tegoprazan reduced gastrointestinal bleeding by 28% (HR 0.72) and major bleeding by 31% (HR 0.69) versus PPIs without increasing ischemic events in AMI patients on DAPT.