Impact of proton pump inhibitors on clinical outcomes and adverse drug reactions in antiplatelet therapy: A prospective study from an Indian hospital

Abstract

Background

Coronary artery disease (CAD) management relies on antiplatelet therapy to prevent atherothrombotic events but increases gastrointestinal (GI) bleeding risk. Proton pump inhibitors (PPIs) are recommended for gastroprotection, though their effect on cardiovascular outcomes remains debated.

Objectives

To evaluate the impact of PPI co-therapy on GI bleeding, cardiovascular events, adverse drug reactions (ADRs), and drug–drug interactions (DDIs) in patients on mono or dual antiplatelet therapy.

Methods

A prospective observational study was conducted over 4 months in a tertiary care hospital. Patients on mono (MAPT) or dual antiplatelet therapy (DAPT), with or without PPIs, were included. Data on demographics, clinical outcomes, ADRs, and DDIs were analyzed.

Results

Of 174 patients, 48 received DAPT + PPI, 62 DAPT only, 34 MAPT + PPI, and 30 MAPT only. GI bleeding incidence was lower in PPI groups (DAPT + PPI: 6.25%, MAPT + PPI: 2.9%) versus non-PPI groups (DAPT only: 21%, MAPT only: 13.3%). Cardiovascular outcomes were unaffected (Myocardial Infarction: 27.1% vs 38.7% in DAPT + PPI vs DAPT only). 91 ADRs were reported, mainly GI bleeding (23.1%) and dyspnea (16.5%). Major DDIs included aspirin + clopidogrel (24.8%) and aspirin + ticagrelor (17.3%).

Conclusion

PPI co-prescription significantly reduced GI bleeding without compromising cardiovascular outcomes, supporting guideline-based prophylaxis in CAD patients receiving antiplatelet therapy.