Trials of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention Lack Strategies to Ensure Appropriate Gastroprotection

Abstract

Introduction: Gastrointestinal bleeding is a morbid complication of dual antiplatelet therapy (DAPT). We evaluated the extent to which contemporary trials of DAPT included steps to ensure appropriate use of proton pump inhibitor (PPI) gastroprotection and reported rates of PPI use.

Methods: A methodological review of randomized trials comparing varying durations of DAPT after percutaneous coronary intervention.

Results: Among 21 trials, none incorporated protocol procedures or guidance for prescribing PPIs. Five reported rates of PPI use (range 25.6-69.1%).

Discussion: PPI gastroprotection is overlooked in major trials of DAPT. Appropriate use of PPI gastroprotection represents an important opportunity to improve patient safety.

Conflict of interest statement

Disclosures

Geoffrey Barnes discloses grant funding from Pfizer/Bristol-Myers Squibb and consulting fees from Pfizer/Bristol-Myers Squibb, Janssen, Portola, and AMAG Pharmaceuticals. Devraj Sukul receives salary support from Blue Cross Blue Shield of Michigan (BCBSM). However, the opinions, beliefs and viewpoints expressed by the authors do not necessarily reflect those of BCBSM or any of its employees. Hitinder Gurm receives research support from Blue Cross and Blue Shield of Michigan, the National Institutes of Health Center for Accelerated Innovations, and Michigan Translational Research and Commercialization for Life Sciences Innovation Hub and is a consultant for Osprey Medical. None of the other authors report any conflicts of interest.

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