Effect of Potassium-Competitive Acid Blockers on Upper Gastrointestinal Bleeding in Patients on Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: A Nationwide Cohort Study

Abstract

Background and Aim Proton pump inhibitors (PPIs) are the drug of choice to prevent upper gastrointestinal (UGI) bleeding in patients receiving dual antiplatelet therapy (DAPT); however, unmet needs remain. Potassium-competitive acid blockers (P-CABs) are novel acid-suppressive drugs that have emerged as potential alternatives. We evaluated the effectiveness of P-CAB in reducing the risk of UGI bleeding in patients receiving DAPT after percutaneous coronary intervention (PCI). Methods This retrospective cohort study included patients with PCI on DAPT between January 2019 and January 2023 using the Korean nationwide health claims database. The primary outcome was admission for UGI bleeding within 6 months of PCI. A multivariate Cox regression model was used to evaluate UGI bleeding risk based on PPIs and P-CAB use. Results Of the 210 447 patients who underwent PCI on DAPT (mean age, 65.5 years; 74.7% men), 4.6% and 47.5% patients were prescribed P-CABs and PPIs, respectively. Overall, 0.3% of patients experienced UGI bleeding within 6 months of PCI. P-CAB users had a reduced risk of UGI bleeding (adjusted hazard ratio, 0.59; 95% confidence interval, 0.38-0.92; p = 0.019) compared with patients not receiving P-CAB or PPI. No significant difference was observed between the P-CAB and PPI users (p > 0.05). Conclusions Among Korean patients undergoing PCI with DAPT, P-CABs reduced UGI bleeding comparably to PPIs. These findings suggest that P-CABs are potential alternatives to PPIs for preventing UGI bleeding.