Abrignani MG, Lombardo A, Braschi A, Renda N, Abrignani V. Proton pump inhibitors and gastroprotection in patients treated with antithrombotic drugs: A cardiologic point of view. World J Cardiol 2023; 15(8): 375-394 [PMID: 37771340 DOI: 10.4330/wjc.v15.i8.375]
Corresponding Author of This Article
Maurizio Giuseppe Abrignani, MD, Doctor, Operative Unit of Cardiology, P. Borsellino Hospital, ASP Trapani, 175 Via Salemi, Marsala 91025, Trapani, Italy. maur.abri@alice.it
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Aug 26, 2023; 15(8): 375-394 Published online Aug 26, 2023. doi: 10.4330/wjc.v15.i8.375
Proton pump inhibitors and gastroprotection in patients treated with antithrombotic drugs: A cardiologic point of view
Maurizio Giuseppe Abrignani, Alberto Lombardo, Annabella Braschi, Nicolò Renda, Vincenzo Abrignani
Maurizio Giuseppe Abrignani, Operative Unit of Cardiology, P. Borsellino Hospital, ASP Trapani, Marsala 91025, Trapani, Italy
Alberto Lombardo, Operative Unit of Cardiology, S. Antonio Abate Hospital, ASP Trapani, Erice 91100, Trapani, Italy
Annabella Braschi, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo 90100, Italy
Nicolò Renda, Department of Direction, CTA Salus, Gibellina 91024, Trapani, Italy
Vincenzo Abrignani, Operative Unit of Internal Medicine with Stroke Care, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) “G. D’Alessandro”, University of Palermo, Palermo 90100, Italy
Author contributions: Abrignani MG was responsible for the conception and design of the manuscript, and he wrote the first original draft; Lombardo A, Braschi A, Renda N, Abrignani V, and Lombardo RM contributed to the design of the manuscript and made critical revisions for important intellectual content; all authors gave final approval of the version of the article to be published.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maurizio Giuseppe Abrignani, MD, Doctor, Operative Unit of Cardiology, P. Borsellino Hospital, ASP Trapani, 175 Via Salemi, Marsala 91025, Trapani, Italy. maur.abri@alice.it
Received: May 6, 2023 Peer-review started: May 6, 2023 First decision: May 19, 2023 Revised: June 23, 2023 Accepted: August 8, 2023 Article in press: August 8, 2023 Published online: August 26, 2023 Processing time: 106 Days and 22.2 Hours
Abstract
Aspirin, other antiplatelet agents, and anticoagulant drugs are used across a wide spectrum of cardiovascular and cerebrovascular diseases. A concomitant proton pump inhibitor (PPI) treatment is often prescribed in these patients, as gastrointestinal complications are relatively frequent. On the other hand, a potential increased risk of cardiovascular events has been suggested in patients treated with PPIs; in particular, it has been discussed whether these drugs may reduce the cardiovascular protection of clopidogrel, due to pharmacodynamic and pharmacokinetic interactions through hepatic metabolism. Previously, the concomitant use of clopidogrel and omeprazole or esomeprazole has been discouraged. In contrast, it remains less known whether PPI use may affect the clinical efficacy of ticagrelor and prasugrel, new P2Y12 receptor antagonists. Current guidelines recommend PPI use in combination with antiplatelet treatment in patients with risk factors for gastrointestinal bleeding, including advanced age, concurrent use of anticoagulants, steroids, or non-steroidal anti-inflammatory drugs, and Helicobacter pylori (H. pylori) infection. In patients taking oral anticoagulant with risk factors for gastrointestinal bleeding, PPIs could be recommended, even if their usefulness deserves further data. H. pylori infection should always be investigated and treated in patients with a history of peptic ulcer disease (with or without complication) treated with antithrombotic drugs. The present review summarizes the current knowledge regarding the widespread combined use of platelet inhibitors, anticoagulants, and PPIs, discussing consequent clinical implications.
Core Tip: Antiplatelet and anticoagulant drugs are used across a wide spectrum of cardio-cerebrovascular diseases, but they are related to relatively frequent gastrointestinal bleeding complications, thus requiring a concomitant proton pump inhibitor (PPI) treatment. On the other hand, a potential increased cardiovascular risk has been suggested in patients treated with PPIs. Current guidelines recommend PPI use in combination with antiplatelet treatment in patients with risk factors for gastrointestinal bleeding. In patients taking oral anticoagulant with risk factors for gastrointestinal bleeding, PPIs could also be recommended, even if their usefulness deserves further data. The present review summarizes the current knowledge on this topic.
