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The following question refers to Section 4.9 of the 2021 ESC CV Prevention Guidelines. The question is asked by\xa0Dr. Christian Faaborg-Andersen, answered first by UCSD fellow\xa0Dr. Patrick Azcarate, and then by expert faculty\xa0Dr. Melissa Tracy.\n\nDr. Tracy is a preventive cardiologist, former Director of the Echocardiography Lab, Director of Cardiac Rehabilitation, and solid organ transplant cardiologist at Rush University.\n\nThe CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines\xa0represents a collaboration with the\xa0ACC Prevention of CVD Section, the\xa0National Lipid Association, and\xa0Preventive Cardiovascular Nurses Association.\n\nQuestion #17\n\nA 74-year-old man with a history of hypertension, chronic kidney disease, and gastroesophageal reflux presents with chest pain and is found to have an NSTEMI due to an obstructive lesion in the proximal LAD. One drug-eluting stent is placed, and he is started on dual antiplatelet therapy with aspirin and clopidogrel. He is concerned about the risk of bleeding from his gastrointestinal tract. What would you recommend to reduce his risk of bleeding?\n\nA. Lansoprazole, a proton pump inhibitor\nB. Famotidine, a histamine-2 blocker\nC. Calcium carbonate, an antacid\nD. None, proton pump inhibitors are contraindicated.\n\nAnswer #17\n\nThe correct answer is A.\n\nThe ESC recommends that patients at high risk for GI bleeding who are receiving antiplatelet therapy take proton pump inhibitors (Class I, LOE A). High risk for bleeding includes patients who are age \u226565, history of peptic ulcer disease, Helicobacter pylori infection, dyspepsia or GERD symptoms, chronic renal failure, diabetes mellitus, and concomitant use of other antiplatelet agents, anticoagulants, nonsteroidal anti-inflammatory drugs, or steroids.\n\nCoadministration of proton pump inhibitors that specifically inhibit CYP2C19 (omeprazole or esomeprazole) may reduce the pharmacodynamic response to clopidogrel. Although this interaction has not been shown to affect the risk of ischemic events, coadministration of omeprazole or esomeprazole with clopidogrel is not recommended.\n\nMain Takeaway\n\nIn patients with high gastrointestinal bleeding risk who are receiving antiplatelet therapy, proton pump inhibitors are recommended. Omeprazole and esomeprazole may reduce the efficacy of clopidogrel and should not be used concomitantly with clopidogrel.\n\nGuideline Location\n\nSection 4.9.3, Page 3291\n\nFigure 13 page 3278; recommendation table page 3279.\n\n\n\nCardioNerds Decipher the Guidelines - 2021 ESC Prevention Series\nCardioNerds Episode Page\nCardioNerds Academy\nCardionerds Healy Honor Roll\n\nCardioNerds Journal Club\nSubscribe to The Heartbeat Newsletter!\nCheck out CardioNerds SWAG!\nBecome a CardioNerds Patron!