Clinical Impact of Proton Pump Inhibitors on the Action of Aspirin

Aspirin is the most potent drug with widespread use. It exist anti-inflammatory, anti-pyretic and well defined anti-platelet activity. Low-dose aspirin is commonly used for cardiovascular and cerebro-vascular diseases. Treatment and prevention of cardiovascular events require long term use of low-dose aspirin. However, long term use of aspirin is associated with major adverse effects of gastro-intestinal bleeding. This may results in non-adherence of aspirin leading high rate of mortality. To prevent this, clinical guidelines recommended the use of proton pump inhibitors as a co-therapy with aspirin. Being a gastro-protective, it is mainly prescribed for the secondary prevention of aspirin-induced bleeding. It exerts its action by suppressing the gastric acid secretion and altering the gastric PH. Aspirin, which is a weak organic acid, requires the acidic medium for better absorption. Co-therapy with proton pump inhibitors reduces the absorption of aspirin. Thus, proton pump inhibitors attenuate the anti-platelet effect of aspirin. However, many researchers do not support this data and suggest use of proton pump inhibitors is considered to be safe and effective. Many studies do not report any clinical evidence of such interaction except the few. Thus, clinical guidelines encouraged for further investigation regarding such interaction for better clinical impact in future. Till then proton pump inhibitors can be practised safely and effectively in aspirin users. Moreover, it suggest for the appropriate selection of proton pump inhibitors. Selection of proton pump inhibitors should be based on the risk-benefit ratio. It must be prescribed only to the patients who are at high risk of gastro-intestinal bleeding. Further studies have to be conducted to evaluate the drug interaction really exist or not. The current article reviews and summarizes the clinical impact of proton pump inhibitors in long term aspirin users.