PPI reduces bleeding from gastroduodenal lesions during antiplatelet/anticoagulant treatment
Co-therapy with proton pump inhibitors (PPIs) in patients receiving low-dose anticoagulation and/or aspirin for stable cardiovascular disease (CVD) confers no benefit for upper gastrointestinal events but may reduce bleeding due to gastroduodenal lesions, a study has shown.
Researchers randomized 17,598 patients with stable CVD and peripheral artery disease to receive either pantoprazole 40 mg daily or placebo in addition to rivaroxaban 2.5 mg twice daily plus aspirin 100 mg once daily, rivaroxaban 5 mg twice daily, or aspirin 100 mg alone.
The primary outcome was a composite of overt bleeding, upper gastrointestinal bleeding from a gastroduodenal lesion or of unknown origin, occult bleeding, symptomatic gastroduodenal ulcer or ≥5 erosions, upper gastrointestinal obstruction, or perforation.
Upper gastrointestinal events overall did not significantly differ between the pantoprazole and placebo groups (102/8,791 vs 116/8,807 events; hazard ratio [HR], 0.88, 95 percent CI, 0.67–1.15).
However, pantoprazole was significantly protective against bleeding from gastroduodenal lesions (HR, 0.52, 0.28–0.94; p=0.03). This effect was more pronounced when a posthoc definition of bleeding gastroduodenal lesion was used (HR, 0.45, 0.27–0.74), although the number needed to treat still was high (982; 609–2,528).
PPIs reduce gastric acid production, promote ulcer healing and prevent ulcer recurrence. PPIs are also gastroprotective in patients taking either antiplatelet drugs or nonselective nonsteroidal anti-inflammatory drugs. [Gastroenterology 2016;151:1105-1112.e10]