Do PPIs Prevent GI Bleeding in Patients on Aspirin and Direct Oral Anticoagulants?

Proton-pump inhibitors did not reduce upper gastrointestinal bleeding in patients with stable cardiovascular disease.

The use of aspirin and anticoagulants to prevent cardiovascular events in high-risk patients has been associated with an increased risk of upper gastrointestinal (GI) bleeding. Current guidelines suggest that proton-pump inhibitors (PPIs) should be used to reduce bleeding in this setting.

Now, investigators have conducted a prospective, double-blind, placebo-controlled trial to evaluate whether PPI therapy reduced the risk for upper GI bleeding in 17,598 patients with stable cardiovascular disease and at low risk for GI bleeding. Patients were randomized to receive the PPI pantoprazole (40 mg once daily) or placebo and were also randomized to receive the direct oral anticoagulant rivaroxaban with aspirin, rivaroxaban alone, or aspirin alone…

Reviewing Author

John R. Saltzman, MD

Disclosures

Consultant/Advisory BoardIterative Scopes

Editorial BoardsGastrointestinal Endoscopy; UpToDate

Leadership Positions in Professional SocietiesAmerican College of Gastroenterology (Trustee)

OtherVice President of Medical Affairs, 1Globe Health Institute