Tag Archives: proton pump inhibitors

Introduction Dual antiplatelet therapy (DAPT) comprises a combination of aspirin and thienopyridine agents, such as clopidogrel, prasugrel and ticagrelor. DAPT is the cornerstone of treatment of patients presenting with acute coronary syndrome (ACS), undergoing either medical therapy alone or percutaneous coronary intervention (PCI).1,2 There has been considerable progress in the treatment of ACS with the advent of more potent agents, in addition to therapeutic anticoagulation. DAPT has contributed to improved outcomes in patients presenting with ACS, with numerous studies showing a marked reduction in major adverse cardiovascular and cerebr

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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PPIs are often prescribed for patients treated with clopidogrel and aspirin following ACS to reduce the risk of gastrointestinal bleeding. But it is thought that they can inhibit the cytochrome P450 isoenzymes that convert clopidogrel to its active metabolite, and these latest results suggest that such prophylactic prescribing of PPIs in this group of patients is not recommended, and that other gastro-protective agents may be preferable, the study authors comment. For their study, they identified 8,205 patients with ACS taking clopidogrel after hospital discharge, of whom 64% were prescribed a PPI. The primary end point, the risk of death or