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Evidence regarding potential drug–drug interactions between P2Y12 inhibitors and tegoprazan remains scarce.
In acute myocardial infarction patients receiving DAPT after PCI, tegoprazan reduces gastrointestinal and major bleeding while maintaining ischemic safety.
Evidence regarding potential drug–drug interactions between P2Y12 inhibitors and tegoprazan remains scarce. This real-world study explored whether tegoprazan, a potassium-competitive acid blocker (P-CAB), differs from proton pump inhibitors (PPIs) in terms of bleeding and ischemic outcomes among patients receiving dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) with drug-eluting stents for acute myocardial infarction (AMI).
Using nationwide claims data from the Korean National Health Insurance Service (NHIS), a retrospective cohort analysis of 21,276 AMI patients who received DAPT after PCI was conducted. Patients were treated with either tegoprazan (n = 2,075) or PPIs (n = 19,201) for gastrointestinal (GI) protection.
Effectiveness outcomes included recurrent myocardial infarction and ischemic stroke. Safety endpoints were GI bleeding and major bleeding at 1 year. Net adverse clinical events (NACE) were characterized as a composite of stroke, major bleeding, and myocardial infarction. For reducing confounding, propensity score matching was utilized.
The mean patient age was 65.2 ± 12.6 years and 75.8% were male. In the propensity-matched population, tegoprazan use was linked with considerably lower bleeding risk when compared with PPIs. Specifically, tegoprazan lowered the incidence of GI bleeding (hazard ratio [HR] 0.72; P = 0.04) and major bleeding (HR 0.69; P = 0.04).
Importantly, the rates of myocardial infarction (HR 0.83; P = 0.43) and stroke (HR 0.95; P = 0.89) were comparable between groups. Overall, NACE was considerably lower in those receiving tegoprazan (HR 0.75; P = 0.03).
In this large real-world analysis of AMI patients receiving DAPT after PCI, tegoprazan exhibited a superior bleeding safety profile compared with PPIs, without compromising protection against ischemic events. These findings support the potential role of tegoprazan as an effective and safer gastroprotective strategy in high-risk cardiovascular patients, although prospective randomized studies are required for confirmation.
European Heart Journal
Safety and effectiveness of tegoprazan in patients treated with dual antiplatelet therapy after drug-eluting stent implantation for acute myocardial infarction
O H Lee et al.
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