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Dual antiplatelet therapy and upper gastrointestinal bleeding risk: do PPIs make any difference?

September 2013 Br J Cardiol 2013;20:148 doi:10.5837/bjc.2013.029

Dual antiplatelet therapy and upper gastrointestinal bleeding risk: do PPIs make any difference?

Inamul Haq, Fazal-ur-Rehman Ali, Shakeel Ahmed, Steven Lindsay, Sudantha Bulugahapitiya

Abstract

Introduction Dual antiplatelet therapy (DAT) with aspirin and clopidogrel is recommended for up to one year following acute coronary syndrome (ACS) in order to reduce the risk of further cardiac events.1,2 Gastrointestinal bleeding is the main hazard of this treatment; however, although the incidence of bleeding is low, it results in significantly increased morbidity and mortality in these patients,3-5 and proton pump inhibitors (PPIs) are often prescribed to selective patients to reduce this risk. PPIs act by reducing the secretion of gastric acid, neutralising gastric pH, increasing clot formation and decreasing the lysis of blood clots. Th

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