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Antithrombotic therapies escalate the likelihood of upper gastrointestinal (GI) bleeding, particularly in elderly people or those with prior GI events.
Low-dose rabeprazole (5 mg) prevents gastrointestinal complications in high bleeding risk patients on chronic antithrombotic therapy.
Antithrombotic therapies escalate the likelihood of upper gastrointestinal (GI) bleeding, particularly in elderly people or those with prior GI events. Although proton pump inhibitors (PPIs) are recommended to reduce this risk, the optimal agent and dosing strategy remain unclear. Researchers investigated whether low-dose rabeprazole (LORA, 5 mg) could effectively prevent GI complications in patients with high bleeding risk (HBR) receiving chronic antithrombotic therapy.
A prospective, interventional study was conducted involving 909 South Korean patients receiving long-term antithrombotic treatment. The cohort exhibited a mean age of 72.9 ± 8.3 years, with 71.3% male participants (n = 648). HBR was defined by factors such as advanced age (≥70 years), dual antiplatelet therapy, combined antithrombotic regimens, and a history of GI bleeding.
Participants received 5 mg of rabeprazole daily and were followed for a median of 364 days. The primary endpoint assessed significant GI events, including overt/occult bleeding and symptomatic peptic ulcers. Secondary endpoints included discontinuation due to GI symptoms, cardiovascular events, and mortality. Adherence and adverse events were closely monitored.
Subjects were followed for a median duration of 364 days (interquartile range 350–385). Most participants exhibited one or two HBR characteristics. Importantly, no cases of significant upper GI bleeding or symptomatic peptic ulcer disease were reported during LORA therapy. Treatment adherence remained high, with a median compliance rate of 92%. GI-related adverse events were infrequent and generally mild, and serious cardiovascular or bleeding complications were rare (Table 1).
LORA reliably prevented GI complications in HBR patients on chronic antithrombotic therapy, demonstrating excellent safety and adherence. These results position it as a valuable prophylactic option, warranting validation in larger, more diverse populations.
European Heart Journal
LOw-dose RAbeprazole therapy for reducing gastrointestinal events in patients with High Bleeding Risk (LORA-HBR): a prospective, multicenter, interventional study
E J Park et al.
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