Upper gastrointestinal bleeding in Japanese patients with ischemic heart disease receiving vonoprazan or a proton pump inhibitor with multiple antithrombotic agents: A nationwide database study

Abstract

Antiplatelet agents including low-dose aspirin (LDA) or adenosine diphosphate (ADP) receptor antagonists are widely used for the prevention of cardiovascular events. However, antiplatelet agents increase the risk of bleeding associated with mucosal breaks in the gastrointestinal (GI) tract [1,2]. Because GI bleeding is independently associated with mortality and ischemic compilations, and temporary cessation of antiplatelet agents increases the risk of mortality, GI bleeding prevention is important during therapy [2-5]. Concomitant use of a proton pump inhibitor (PPI) is regarded as appropriate in patients with multiple risk factors for GI bleeding who require antiplatelet therapy [6]. Risk factors for GI bleeding include a history of bleeding or other complications of peptic ulcer disease [7,8], advanced age, use of steroids or non-steroidal anti-inflammatory drugs (NSAIDs) [9-15], and concomitant use of 2 antithrombotic agents [i.e. dual antiplatelet therapy (DAPT)] [1,16-19]. Vonoprazan (TAK-438) belongs to a class of acid-inhibitory agents known as potassium-competitive acid blockers (P-CABs), which reversibly inhibit H + , K +-ATPase independently of acid pH

Ischemic/bleeding event after short dual-antiplatelet therapy in patients with high bleeding risk: Sub-analysis of the MODEL U-SES study

“…Contrary to the recent meta-analysis, our result showed aspirin monotherapy after short DAPT has comparable bleeding events as compared to P2Y 12 inhibitor after DAPT. The reason why the comparable incidence of ischemic/bleeding events between aspirin and P2Y 12 inhibitor might be explained by high prescription of PPI, including potassium-competitive acid blockers [39] , and optimal medical therapy, i.e. statin (82.1% of population), for preventing atherothrombotic events in our cohort.…”

Re-bleeding and all-cause mortality risk in non-variceal upper gastrointestinal bleeding: focusing on patients receiving oral anticoagulant therapy

“…In a study that compared vonoprazan and lansoprazole for the treatment of PUs, an acid-related disease, it was confirmed that both had similar tolerability profiles; vonoprazan was not less effective in treating gastric ulcer and duodenal ulcer [ 40 ]. Furthermore, in a previous study conducted in Japan, the non-inferiority of vonoprozan to PPI in the treatment of UGIB that occurred for 6 months in patients with ischemic heart disease receiving two or more antithrombotic agents was confirmed [ 41 ]. This may help reduce the risk of re-bleeding in patients with NVUGIB receiving OACs by maintaining an increased intragastric pH for a longer period.…”

Intermittent Proton Pump Inhibitor Therapy in Low-Risk Non-Variceal Upper Gastrointestinal Bleeding May Be Significantly Cost-Saving

“…As of mid-2023, there are no published manuscripts specifically addressing the use of P-CABs in NV-UGIB. A nationwide database study in Japan showed non-inferiority of vonoprazan compared to PPIs in rates of NV-UGIB in patients with ischemic heart disease receiving multiple anti-thrombotic medications [ 40 ]. There are multiple studies that comment on the effect of vonoprazan compared to PPIs for iatrogenic gastric or duodenal ulcers as a result of endoscopic submucosal dissection, with most finding an advantage with vonoprazan [ 41 , 42 ].…”