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P-CAB vs. PPI for Upper Gastrointestinal Bleeding Prevention in Patients With Atherothrombotic Disease on
Min Joo Yoon1, Soyoung Lee2, Hye-Kyung Jung1
1Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
Insights
Potassium-competitive acid blockers (P-CABs) significantly reduce upper gastrointestinal bleeding risk compared to proton pump inhibitors (PPIs) in patients on antithrombotic therapy. This suggests P-CABs offer superior gastroprotection for high-risk individuals.
Area of Science:
- Gastroenterology and Hepatology
- Cardiology and Cardiovascular Diseases
- Pharmacology and Therapeutics
Background:
- Randomized trials indicate potassium-competitive acid blockers (P-CABs) outperform proton pump inhibitors (PPIs) in preventing ulcer recurrence in high-risk aspirin users.
- Real-world comparative effectiveness of P-CABs versus PPIs across diverse antithrombotic regimens for upper gastrointestinal (GI) bleeding prevention is not well-defined.
Purpose of the Study:
- To evaluate the comparative effectiveness of P-CABs versus PPIs in preventing upper GI bleeding.
- To assess P-CABs and PPIs in patients with acute atherothrombotic disease undergoing antithrombotic therapy.
Main Methods:
- Retrospective cohort study using hospital-based Common Data Model data from 2018-2024.
- Included patients with acute cardiovascular or cerebrovascular disease on antithrombotic therapy who initiated either a PPI or P-CAB.
- Time-dependent Cox regression analysis adjusted for confounders, with drug exposure modeled as a time-varying variable to mitigate immortal-time bias.
Main Results:
- Among 2255 patients (1726 on PPIs, 529 on P-CABs), P-CAB use was associated with a significantly lower risk of upper GI bleeding (adjusted hazard ratio [HR] 0.22; p=0.016).
- P-CABs demonstrated a profound reduction in moderate-to-severe upper GI bleeding (HR 0.11; p=0.011).
- No upper GI bleeding events were observed in P-CAB users with a high antithrombotic burden (≥2 agents).
Conclusions:
- P-CABs are associated with a significantly lower risk of clinically significant GI bleeding compared to PPIs in patients on antithrombotic therapy.
- These findings support P-CABs as a potent acid-suppressive strategy for gastroprotection in high-risk populations undergoing antithrombotic treatment.
Background:
Randomised trials have suggested the benefit of potassium-competitive acid blockers (P-CABs) is superior to proton pump inhibitors (PPIs) for ulcer recurrence in high-risk aspirin users. However, real-world comparative effectiveness across diverse antithrombotic regimens remains poorly defined.
Objective:
We evaluated P-CABs versus PPIs for preventing upper gastrointestinal (GI) bleeding in patients with acute atherothrombotic disease and using antithrombotic therapy.
Design:
This retrospective cohort study utilised hospital-based Common Data Model data (2018-2024). Patients with acute cardiovascular or cerebrovascular disease receiving antithrombotic therapy who initiated a PPI or P-CAB were included. Drug exposure was modelled as a time-varying variable to mitigate immortal-time bias. The primary outcome was upper GI bleeding, analysed via time-dependent Cox regression adjusted for age, sex, comorbidities, and concomitant medications.
Results:
Among 2255 patients (PPI: 1726; P-CAB: 529) in which 53 upper GI bleeding events occurred during a median follow-up of 637 days. P-CAB use was associated with a significantly lower risk of upper GI bleeding than PPIs (incidence rate 5.7 vs. 25.8 per 1000 person-year; adjusted hazard ratio [HR] 0.22, 95% CI 0.06-0.75, p = 0.016). P-CABs showed a profound reduction in moderate-to-severe upper GI bleeding (HR 0.11, 95% CI 0.02-0.60; p = 0.011). Notably, no bleeding events occurred in P-CAB users with high antithrombotic burden (≥ 2 agents).
Conclusions:
In patients receiving antithrombotic therapy, P-CABs are associated with a significantly lower risk of clinically significant GI bleeding compared to PPIs. These findings support P-CABs as a potent acid-suppressive strategy for gastroprotection in high-risk populations.
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