Evaluation of Rabeprazole for Gastrointestinal Protection in Acute Coronary Syndrome Patients Treated with Aspirin and Ticagrelor: A Pilot Study

Abstract

Purpose: Patients with acute coronary syndrome (ACS) on ticagrelor-based dual antiplatelet therapy (DAPT) have an increased risk of gastrointestinal (GI) bleeding. However, evidence supporting the protective role of proton pump inhibitors against DAPT-induced gastric mucosal injury remains limited. Materials and Methods: This was a single-center, prospective, open-label, observational trial enrolling patients with ACS who were treated with DAPT, specifically aspirin and ticagrelor, following percutaneous coronary intervention in South Korea. Participants received 20 mg rabeprazole once daily for 8 weeks. The primary outcome was the proportion of patients exhibiting a modified Lanza score (MLS) of 0-5 on upper endoscopy at 8 weeks compared to baseline endoscopy results. The secondary outcomes included GI symptom scores and safety assessments. Results: Among the 50 patients included in the per-protocol analysis, the median MLS at baseline and 8 weeks was 2.0 (1.0-2.0) and 2.0 (1.0-2.0), respectively, with no significant change (p=0.69). Similarly, in patients at high-risk for GI bleeding (76.0%, 38/50), there was no significant difference in MLS after 8 weeks of treatment with rabeprazole compared to the baseline MLS, consistent with the results of the overall study population. GI symptom scores, including the Nepean Dyspepsia Index-Korean, Gastroesophageal Reflux Disease (GERD) Questionnaire, and GERD Health-Related Quality of Life Questionnaires, showed no significant changes from baseline in the overall cohort and high-risk groups. No major bleeding or adverse cardiac events were observed. Conclusion: In this pilot study, rabeprazole was associated with maintained gastric mucosal integrity in patients with ACS receiving ticagrelor-based DAPT.