Proton Pump Inhibitor Use Guidelines

Indications and Duration

The American Heart Association recommends that PPIs should be used in patients with a history of prior GI bleeding who require dual antiplatelet therapy (DAPT) 1, 2, 3
The American Heart Association suggests that PPIs are reasonable in patients with increased risk of GI bleeding (e.g., advanced age, concomitant use of warfarin, steroids, NSAIDs, Helicobacter pylori infection) who require DAPT 1, 2, 3
The American Heart Association recommends that routine use of PPIs is not recommended for patients at low risk of GI bleeding 1, 2, 3
The American College of Cardiology recommends that for patients on DAPT after coronary stent placement, the duration of PPI use should match DAPT therapy 1, 3, 4

The American College of Cardiology recommends that high-risk patients, including those over 60-65 years on DAPT or anticoagulants, should continue PPI use 5
The American Heart Association recommends that patients with a history of upper GI bleeding should continue PPI use 3, 5
The American College of Cardiology suggests that patients with concurrent use of multiple antithrombotics should continue PPI use 4, 5
The American College of Cardiology recommends that patients who discontinue PPI therapy may experience transient upper GI symptoms due to rebound acid hypersecretion, which typically resolves within 2-6 months 5

The American College of Cardiology recommends that for patients requiring both PPIs and antacids, separate administration by at least 2 hours as antacids can significantly reduce PPI absorption and effectiveness 6
The American College of Cardiology suggests that PPIs should be taken 30-60 minutes before meals for optimal effectiveness 6