Co-prescription of Dual-Antiplatelet Therapy and Proton Pump Inhibitors: Current Guidelines

Hannah Saven; Lynna Zhong; Isabel M McFarlane

doi:10.7759/cureus.21885

Co-prescription of Dual-Antiplatelet Therapy and Proton Pump Inhibitors: Current Guidelines

Cureus. 2022 Feb 3;14(2):e21885. doi: 10.7759/cureus.21885. eCollection 2022 Feb.

Authors

Hannah Saven¹, Lynna Zhong¹, Isabel M McFarlane²

Affiliations

¹ Internal Medicine, State University of New York (SUNY) Downstate College of Medicine, New York, USA.
² Internal Medicine, State University of New York (SUNY) Downstate Medical Center, New York, USA.

Abstract

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.

Keywords: cyp450 pathway; dapt/ppi prescription; dual-antiplatelet therapy (dapt); proton-pump inhibitors (ppi); upper gastrointestinal bleed (ugib).

Publication types

Review