Selecting the Optimal Proton Pump Inhibitor for Patients with Coronary Artery Disease Who Require Dual Antiplatelet Therapy

Authors: O.O. Khaniukov, O.V. Pysarevska, M.G. Getman, T.A. Simonova, T.V. Lakiza, State Institution «Dnipropetrovsk Medical Academy of Ministry of Health of Ukraine», Dnipro, Ukraine

Summary

High rate of cardiovascular morbidity dictates the need for wide use of antithrombotic agents in clinical practice. Therapy which based on drugs with different mechanisms of action on the thrombocytic component of homeostasis appears to be especially promising as having synergic antiplatelet effect. The most common antiplatelet therapy is a combination of acetylsalicylic acid and clopidogrel usually referred to as a dual antiplatelet therapy (DAT). Current consensus recommends intake of proton pump inhibitors (PPI) during DAT to reduce the risk of gastrointestinal complications. However, recent studies showed that this approach is associated with severe cardiovascular disorders, such as myocardial infarction, stroke, unstable angina, necessity of coronary interventions, and coronary death. So, it seems to be important to develop strategies for the differential use of PPI in patients receiving DAT. The article presents the reviews of the literature on the above issues with the results of studies of various PPI effect on clinical outcomes in patients taking clopidogrel.

Keywords: proton pump inhibitors; dual antiplatelet therapy; drug interaction; pantoprazole; Ulsеpan