Evolving trends in acid suppression therapy among patients undergoing dual antiplatelet therapy: A Nationwide study in South Korea from 2018 to 2022.

Aims: We aimed to examine the recent trends in the use of acid suppression therapies, including proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs) and potassium-competitive acid blockers (P-CABs), in patients undergoing dual antiplatelet therapy (DAPT) as aspirin-clopidogrel following coronary stent implantation in South Korea between 2018 and 2022.

Methods: This observational study analysed data from the Health Insurance Review and Assessment Service (HIRA) on patients who underwent coronary stent implantation and received aspirin-clopidogrel DAPT. Patients who received acid suppression therapy for >60 days during DAPT were included in the analysis. Trends in the use of PPIs, H2RAs and P-CABs were assessed at 6-month intervals using the Cochran-Armitage trend test.

Results: Of the 128 121 patients studied who received DAPT, 61 731 (48.2%) were prescribed acid suppression therapy. The proportion of patients receiving concomitant acid suppressants with DAPT increased from 42.8% in 2018 to 53.8% in 2022. PPIs were the most commonly used therapies (78.9%), followed by H2RAs (14.6%) and P-CABs (6.5%). PPI use peaked in 2020 and declined thereafter, whereas P-CAB use steadily increased, surpassing that of H2RA by 2021.

Conclusions: The landscape of acid suppression therapy for patients undergoing DAPT has evolved with a growing preference for P-CABs. This shift highlights the need for further research comparing the efficacy and safety of acid suppressants to guide clinical decision making.