Is proton pump inhibitors’ prophylaxis indicated for patients on antiplatelet therapy?

In USA and Europe, more than 50% of adults aged 75 years old or older are taking a lifelong antiplatelet treatment, of which half are for secondary prevention of vascular diseases [1]. The major side effect of the aforementioned therapy is the risk of major bleeding, particularly from the upper gastrointestinal tract. However, clinical guidelines on secondary prevention of vascular events do not recommend proton pump inhibitors (PPIs), which could reduce the incidence of bleeding by 70-90%. This is probably due to the adverse effects of the PPIs, as stated in a recent Mayo Clinic's review [2], and because in aspirin trials, the gastrointestinal bleeds have a low mortality and permanent disability rates. However, most of the populations of the aspirin trials were younger than 75 years of age, and thus, up to now, the agespecific risk of bleeding in patients on long-term antiplatelet treatment after vascular events has not been sufficiently studied