Effect of proton-pump inhibitor and dual anti-platelet therapy

This paper studied the impact of proton-pump inhibitors (PPI) on patients receiving dual anti-platelet therapy. They concluded that the use of proton-pump inhibitors when necessary was not associated with worse outcomes in patients receiving dual anti-platelet therapy. 

Percutaneous coronary intervention is a procedure done to improve blood flow. Patients who receive this procedure require dual anti-platelet therapy. This involves a combination of 2 anti-platelet drugs such as aspirin and clopidogrel (Plavix). These drugs prevent blood from clotting and allows blood to flow smoothly. Because these drugs can cause side effects on the digestive tract, proton-pump inhibitors are given to prevent ulceration or bleeding. A previous study discouraged the use of omeprazole (Prilosec; a proton-pump inhibitor) together with clopidogrel because of reduced efficacy. 

The current study examined the use of a combination of proton-pump inhibitors and dual-platelet therapy.

Patients in the study were randomly assigned to receive either 6 months or 24 months of aspirin and clopidogrel. The administration of proton-pump inhibitor was decided by the physician. 37.5% of patients received a proton-pump inhibitor. Of these patients, 90.9% received lansoprazole (Prevacid) whereas 7.6% received pantoprazole (Protonix).

Patients who received a proton-pump inhibitor were older and more likely female compared to patients who did not receive a proton-pump inhibitor. They also had a higher risk of bleeding in a heart attack.

The rate of death from all causes was similar between patients receiving proton-pump inhibitor and those who did not.

The rate of major bleeding was more frequent in patients receiving proton-pump inhibitors but this difference was not significant. Overall safety was also similar between both groups of patients. The rate of adverse events (undesired effect of treatment) was 12.9% in patients who received proton-pump inhibitors and 14.9% in patients who did not receive a proton-pump inhibitor. 

The authors concluded that the results do not support the need to avoid the use of proton-pump inhibitors together with dual anti-platelet therapy of aspirin and clopidogrel.  

Bleeding specifically from the digestive tract was not analyzed. Thus the benefit of proton-pump inhibitor on digestive tract bleeding could not be analyzed.