{"id":139953,"date":"2026-11-10T22:28:49","date_gmt":"2026-11-11T03:28:49","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=139953"},"modified":"2026-11-10T22:28:50","modified_gmt":"2026-11-11T03:28:50","slug":"vihp-trial-two-week-h-pylori-eradication-noninferior-to-six-months-of-pantoprazole-for-preventing-gi-bleeding-after-pci","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=139953","title":{"rendered":"VIHP Trial: Two-Week H. pylori Eradication Noninferior to Six Months of Pantoprazole for Preventing GI Bleeding After PCI"},"content":{"rendered":"\n<ul class=\"wp-block-list\">\n<li>Dual antiplatelet therapy (DAPT) is essential for preventing ischemic events following percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) but increases the risk of gastrointestinal (GI) bleeding.<\/li>\n\n\n\n<li>Helicobacter pylori (H. pylori) infection is an established risk factor for peptic ulcer disease and GI bleeding. Proton pump inhibitors (PPIs) are commonly prescribed for gastroprotection in patients receiving DAPT.<\/li>\n\n\n\n<li>In the VIHP trial, a 14-day course of vonoprazan and amoxicillin for H. pylori eradication was noninferior to six months of pantoprazole for preventing GI bleeding among H. pylori\u2013positive patients receiving DAPT after PCI.<\/li>\n\n\n\n<li>Rates of major adverse cardiovascular and cerebrovascular events, composite GI events, and adverse events were similar between treatment groups.<\/li>\n\n\n\n<li>These findings suggest that short-course H. pylori eradication may provide an alternative to prolonged PPI prophylaxis in selected patients, potentially reducing medication burden and long-term drug exposure.<\/li>\n<\/ul>\n\n\n\n<p>Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is a cornerstone of treatment following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), significantly reducing the risk of recurrent ischemic events and stent thrombosis. However, prolonged DAPT increases the risk of gastrointestinal (GI) bleeding, a potentially serious complication associated with increased morbidity and mortality. Proton pump inhibitors (PPIs) are frequently prescribed to mitigate this risk, particularly among patients with coexisting risk factors for GI bleeding. One such risk factor is Helicobacter pylori (H. pylori) infection, which contributes to peptic ulcer disease and ulcer-related bleeding. Although long-term PPI therapy provides effective gastroprotection, its effectiveness depends on sustained adherence, and prolonged treatment adds to pill burden. Whether a short course of H. pylori eradication therapy could provide comparable protection against GI bleeding without requiring extended PPI use is uncertain.<\/p>\n\n\n\n<p>On November 7, 2026, at the American Heart Association Scientific Sessions , Jiaojiao Pang, MD, PhD (Qilu Hospital of Shandong University, Jinan, China), presented results from the VIHP trial, which compared a 14-day course of vonoprazan\u2013amoxicillin dual therapy with six months of pantoprazole for preventing GI bleeding in H. pylori\u2013positive patients receiving DAPT following PCI for ACS. Vonoprazan is a potassium-competitive acid blocker that provides rapid and sustained gastric acid suppression, facilitating H. pylori eradication when combined with antibiotics.<\/p>\n\n\n\n<p>The VIHP trial (<a href=\"https:\/\/www.chictr.org.cn\/historyversionpub.html?regno=ChiCTR2500110755\">ChiCTR2500110755<\/a>) was a multicenter, randomized, open-label, noninferiority trial conducted across 34 hospitals in China. Between April 2023 and December 2024, 2,601 patients with ACS who had undergone PCI, tested positive for H. pylori using a carbon-13 urea breath test, and were expected to receive DAPT for at least six months were randomized 1:1 to receive either vonoprazan 20 mg twice daily plus amoxicillin 1 g three times daily for 14 days or pantoprazole 40 mg once daily for six months. Both groups continued background DAPT with aspirin and either clopidogrel or ticagrelor. Patients with previous GI bleeding, those requiring long-term acid suppression, and those receiving anticoagulant therapy were excluded.<\/p>\n\n\n\n<p>The primary endpoint was GI bleeding within six months, with events assessed through blinded adjudication. GI bleeding was defined as the presence of melena and\/or hematemesis, confirmed by gastroscopy or barium meal examination, or a decrease in hemoglobin of \u22652 g\/dL or hematocrit of \u226510% with non-bleeding-related causes excluded. Secondary endpoints included major adverse cardiovascular and cerebrovascular events (MACCE), composite GI events, and safety outcomes.<\/p>\n\n\n\n<p>Of the 2,601 randomized patients, 2,589 were included in the modified intention-to-treat analysis (1,298 in the vonoprazan\u2013amoxicillin group and 1,291 in the pantoprazole group). The median age was 62 years, 71.3% were men, 28.5% had diabetes, and 14.6% had previously undergone PCI.<\/p>\n\n\n\n<p>At six months, GI bleeding occurred in 16 patients (1.2%) receiving vonoprazan\u2013amoxicillin compared with 24 patients (1.9%) receiving pantoprazole. The multiple-imputation analysis demonstrated an absolute risk difference of \u22120.69 percentage points (95% CI: \u22121.69 to 0.31), meeting the prespecified noninferiority criterion (<em>P<\/em>=0.018). The upper confidence interval boundary of 0.31 percentage points remained below the noninferiority margin of 0.378 percentage points. These findings were consistent across complete-case and per-protocol sensitivity analyses. However, superiority of the eradication strategy over pantoprazole was not established.<\/p>\n\n\n\n<p>Secondary outcomes were also comparable between the groups. MACCE occurred in 1.3% of patients receiving vonoprazan\u2013amoxicillin compared with 1.5% receiving pantoprazole (risk difference: \u22120.2 percentage points; 95% CI: \u22121.2 to 0.7). Composite GI events occurred in 4.2% versus 5.7%, respectively (risk difference: \u22121.4 percentage points; 95% CI: \u22123.1 to 0.3). Similarly, adverse events were reported in 3.8% of patients in the eradication group compared with 5.0% in the pantoprazole group (<em>P<\/em>=0.141), with no statistically significant difference between treatment strategies.<\/p>\n\n\n\n<p>Importantly, the H. pylori eradication rate with vonoprazan\u2013amoxicillin was 84.7% (986 of 1,164 patients assessed), while treatment adherence was high in both groups (95.7% and 94.6%, respectively). These findings suggest that a finite two-week eradication regimen may provide an alternative approach to gastroprotection while potentially reducing medication burden and prolonged acid-suppressive therapy.<\/p>\n\n\n\n<p>Several limitations warrant consideration. The study excluded patients with previous GI bleeding and those receiving anticoagulation, potentially limiting the generalizability of the findings to patients at higher bleeding risk. Additionally, the six-month follow-up period does not establish whether the benefits of H. pylori eradication persist over the longer term. Although bleeding events were independently adjudicated, the open-label design may have introduced reporting bias. Furthermore, 7% of patients assigned to the eradication strategy received PPIs during follow-up, potentially favoring noninferiority, while antimicrobial resistance was not assessed.<\/p>\n\n\n\n<p>The findings suggest that targeted H. pylori eradication may offer a practical alternative to prolonged PPI prophylaxis in selected patients receiving DAPT after PCI. However, the results should not be interpreted as demonstrating superiority over pantoprazole or supporting the routine discontinuation of gastroprotection in patients at high risk of GI bleeding. Further studies are needed to establish the durability of protection and determine whether this strategy can be extended to broader patient populations.<\/p>\n\n\n\n<p>The VIHP trial was sponsored by Qilu Hospital of Shandong University, China.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is a cornerstone of treatment following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), significantly reducing the risk of recurrent ischemic events and stent thrombosis. However, prolonged DAPT increases the risk of gastrointestinal (GI) bleeding, a potentially serious complication associated with increased morbidity and [&hellip;]<\/p>\n","protected":false},"author":40615,"featured_media":139954,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"aside","meta":{"footnotes":"","_ppma_block_editor_authors":""},"categories":[1093,8],"tags":[1094,47,185],"tmauthors":[1095],"ppma_author":[1069],"class_list":{"0":"post-139953","1":"post","2":"type-post","3":"status-publish","4":"format-aside","5":"has-post-thumbnail","7":"category-aha-2026","8":"category-news","9":"tag-aha2026","10":"tag-featured","11":"tag-news","12":"post_format-post-format-aside","13":"author-hassan-adam-alhassan-md"},"authors":[{"term_id":1069,"user_id":40615,"is_guest":0,"slug":"hassan-adam-alhassan-md","display_name":"Hassan Adam Alhassan MD","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/8cc8318e58bf0ad1548b042cbb04e2e62466d8fe5780d7b1f138246f2c21b2b5?s=96&r=g","avatar_alt":"","avatar_decorative":"","author_category":"1","first_name":"Hassan","last_name":"Adam Alhassan","user_url":"","job_title":"Clinical Fellow Electrophysiology BIDMC","description":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/139953","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40615"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=139953"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/139953\/revisions"}],"predecessor-version":[{"id":139955,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/139953\/revisions\/139955"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/139954"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=139953"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=139953"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=139953"},{"taxonomy":"tmauthors","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftmauthors&post=139953"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=139953"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}