The prophylactic use of a proton pump inhibitor (PPI) in patients treated with clopidogrel and aspirin for an acute coronary syndrome or placement of a coronary stent reduces the rate of upper gastrointestinal bleeding with no apparent increase in cardiovascular events

Abstract

Summary In the COGENT trial [5], 3,873 patients with an indication for a dual antiplatelet therapy were randomly assigned to omeprazole or placebo. The primary gastrointestinal (GI) end point was a composite of overt or occult bleeding, symptomatic gastroduodenal ulcers or erosions, obstruction or perforation. The primary cardiovascular end point was a composite of death from cardiovascular causes, nonfatal myocardial infarction, revascularization or stroke. Fiftyone patients presented the primary GI end point, with an event rate of 1.1% in the omeprazole group and 2.9% in the placebo group (hazard ratio 0.34, 95% CI 0.18‐0.63; P 0.001). The number of patients who would need to be treated for 6 months to prevent one occurrence of an event