Abstract
Proton pump inhibitors (PPI) are one of the most widely used drug groups; more than 10% of adult population is chronically treated with them. Often, it concerns patients with high risk of vascular or renal damage.
Aside from the undeniable efficacy in the treatment and prophylaxis of grastroduodenal diseases, PPI were assesrted as common practice in combination with antithrombotic treatment with the aim of lowering the occurrence of intraintestinal bleeding. Evidence for the lowering of bleeding risk with this strategy is only on the level of observational studies; risk decrease by third is significant.
However, with relatively low occurrence of intraintestinal bleeding, the absolute decrease of the risk is small - around 0.3%. Observed value of number-needed-to-treat (NNT) reaches around 250, i.e., for every 250 patients treated with PPI, 1 bleeding is prevented (usually not critical).
On the other hand, there are more and more articles presenting higher occurrence of cardiovascular events, renal failure and nerv damage with PPI treatment. The risk is significant in a population with high cardiovascular risk, i.e., in a typical population where PPI are added to antithrombotic treatment.
The value of number-needed-to-harm (NNH) is around 50. Reasons for higher cardiovascular morbidity and mortality can be numerous, from the actual gastroesophageal affection, over the effect of PPI on the number of transporters or enzymes to the negative impact of PPI with regards to drug interactions