Concomitant Gastrointestinal Bleeding Prophylaxis With Dual Antiplatelet Therapy Usage

Abstract

Gastrointestinal bleeding (GIB) is a critical condition that requires effective management, particularly in patients undergoing dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. This literature review examines the comparative efficacy and safety of proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) in preventing GIB among these patients. PPIs have traditionally been the cornerstone for GIB prophylaxis due to their superior acid-suppressive properties and ability to promote ulcer healing. However, concerns about PPIs potentially inhibiting clopidogrel’s antiplatelet activity via cytochrome P450 2C19 interactions have led to increased interest in H2RAs as an alternative. Emerging research highlights the contexts where H2RAs may be preferred, including in patients with specific cardiovascular or renal comorbidities. Recent findings also explore the role of potassium-competitive acid blockers (PCABs) as a promising alternative to PPIs. Despite conflicting data, this review underscores the need for personalized treatment strategies based on efficacy, safety, and patient-specific factors to optimize GIB prophylaxis in DAPT patients. Further large-scale studies are recommended to address gaps in the literature and refine clinical guidelines.