THE CO-PRESCRIPTION of proton pump inhibitors (PPIs) with dual antiplatelet therapy (DAPT) significantly reduces major gastrointestinal bleeding risk in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI), without increasing cardiovascular events.
Current guidelines differ between Europe and the United States regarding routine PPI use in patients on DAPT following AMI. This study aimed to assess the impact of PPIs on gastrointestinal bleeding and cardiovascular outcomes in this patient group. Given the high risk of bleeding associated with DAPT, understanding the safety and efficacy of PPI co-prescription is crucial for clinical decision-making.
A nationwide Korean claims database was analysed to identify patients with AMI undergoing PCI and receiving DAPT. A propensity score-matching approach generated 35,560 matched patient pairs, comparing those prescribed PPIs to those who were not. Over a one-year period, patients on PPIs had a significantly lower incidence of major gastrointestinal bleeding requiring transfusion and hospitalisation (0.4% vs 0.7%; hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.48-0.73). However, there was no significant difference in major adverse cardiac and cerebrovascular events (MACCE) between the groups (13.1% vs 13.4%; HR 0.98, 95% CI 0.94-1.02). These findings remained consistent regardless of P2Y12 inhibitor type, PPI type, or individual bleeding risk.
These results reinforce the safety and benefit of PPIs in reducing gastrointestinal bleeding in AMI patients treated with DAPT, without elevating cardiovascular risk. The findings support broader adoption of routine PPI co-prescription in clinical practice, particularly for patients at risk of gastrointestinal complications. Future research should assess whether guideline recommendations should be harmonised internationally to reflect these real-world data.
Katrina Thornber, EMJ
Reference
Kang D et al. Effects of proton pump inhibitors on gastrointestinal bleeding and cardiovascular outcomes in myocardial infarction patients treated with DAPT. EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2025;21(4):e229-39.
