Effect of Potassium-Competitive Acid Blockers Compared with Proton Pump Inhibitors on Upper Gastrointestinal Bleeding in Patients with Coronary Artery Disease on Dual Antiplatelet Therapy: A Systematic Review and Meta-Analysis

Abstract

Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) increases the risk of upper gastrointestinal bleeding (UGIB). Proton pump inhibitors (PPIs) are widely used for gastroprotection but have limitations including delayed onset of action and potential interactions with clopidogrel. Potassium-competitive acid blockers (P-CABs) might provide an alternative with more rapid and consistent acid suppression. This systematic review and meta-analysis of observational studies compared P-CABs versus PPIs for the prevention of UGIB in patients receiving DAPT after PCI. Major literature databases were searched for articles published until March 2026. Risk of bias was assessed with ROBINS-I, and pooled odds ratios (ORs) were estimated with random-effects models. Six cohort studies in 42,304 patients were analyzed. No significant difference in UGIB was observed between P-CABs and PPIs (OR 1.03, 95% CI 0.77-1.37; I² = 4%). Sensitivity analysis excluding studies with high risk of bias yielded consistent results (OR 0.96, 95% CI 0.70-1.30). No significant differences were observed in major adverse cardiovascular events or all-cause mortality. The certainty of evidence was very low because of confounding and imprecision. P-CABs appeared comparable to PPIs in preventing UGIB in this population; however, randomized trials are needed.

Keywords

DAPT / UGIB / CAD / P-CABs / PPIs

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