Systematic Review and Meta-Analysis: Role of Proton Pump Inhibitors in Prevention of Upper Gastrointestinal Bleeding in Patients on Dual Antiplatelet Therapy.

IF 2.9 4区 医学 Q2 PHARMACOLOGY & PHARMACY
Aamir Saeed, Marjan Haider, Saira Yousuf, Soban Ahmad, Michael Fine, Ali Yazdani, Umar Hayat, Nicholas Noverati, Muhammad Ali Khan, Manesh Kumar Gangwani, Muhammad Aziz, Umer Farooq, Faisal Kamal
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引用次数: 0

Abstract

Background: Dual antiplatelet therapy (DAPT) with oral P2Y12 inhibitors and aspirin is crucial for patients with acute coronary syndrome (ACS) and postpercutaneous coronary interventions (PCI). Concomitant proton pump inhibitor (PPI) therapy with DAPT can potentially reduce the risk of upper gastrointestinal bleeding (UGIB).

Aim: We conducted a meta-analysis of randomized controlled trials to evaluate the prevention of UGIB with concomitant use of PPI with DAPT.

Methods: We reviewed several databases to identify randomized controlled trials comparing the risk of UGIB in patients using DAPT + PPI vs. DAPT with no PPI or DAPT + Histamine 2 receptor antagonists. Our outcomes of interest were UGIB, major cardiovascular adverse events (MACE), myocardial infarction, and all-cause mortality. We calculated pooled risk ratio (RR) with 95% confidence intervals (CI) for all of the outcomes and analyzed data using random effect model. Heterogeneity was assessed using I2 statistic.

Results: Seven randomized controlled trials comprising 6708 patients were included. Rate of UGIB was significantly lower in the PPI + DAPT group, RR (95% CI): 0.39 (0.25-0.60). There was no significant difference in the rate of MACE between groups, RR (95% CI): 0.87 (0.69-1.10). Rate of MI was also not significantly different between groups, RR (95% CI): 0.93 (0.75-1.14). Rate of mortality was significantly lower in the PPI + DAPT group, RR (95% CI) 0.46 (0.27-0.80).

Conclusions: Our meta-analysis demonstrates that adding PPI therapy to DAPT significantly lowers the risk of UGIB and all-cause mortality, without adversely affecting major cardiovascular outcomes.

系统评价和荟萃分析:质子泵抑制剂在预防双重抗血小板治疗患者上消化道出血中的作用。
背景:口服P2Y12抑制剂和阿司匹林的双重抗血小板治疗(DAPT)对于急性冠脉综合征(ACS)和经皮冠状动脉介入治疗(PCI)患者至关重要。质子泵抑制剂(PPI)与DAPT合用可以潜在地降低上消化道出血(UGIB)的风险。目的:我们进行了一项随机对照试验的荟萃分析,以评估PPI与DAPT联合使用对UGIB的预防作用。方法:我们回顾了几个数据库,以确定随机对照试验,比较使用DAPT + PPI与不使用PPI或DAPT +组胺2受体拮抗剂的患者UGIB的风险。我们感兴趣的结局是UGIB、主要心血管不良事件(MACE)、心肌梗死和全因死亡率。我们计算所有结果的合并风险比(RR), 95%置信区间(CI),并使用随机效应模型分析数据。采用I2统计量评估异质性。结果:纳入7项随机对照试验,6708例患者。PPI + DAPT组UGIB发生率明显降低,RR (95% CI): 0.39(0.25 ~ 0.60)。两组间MACE发生率差异无统计学意义,RR (95% CI): 0.87(0.69 ~ 1.10)。心肌梗死发生率组间差异无统计学意义,RR (95% CI): 0.93(0.75 ~ 1.14)。PPI + DAPT组的死亡率显著降低,RR (95% CI) 0.46(0.27 ~ 0.80)。结论:我们的荟萃分析表明,在DAPT中加入PPI治疗可显著降低UGIB和全因死亡率的风险,而不会对主要心血管结局产生不利影响。
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来源期刊
American journal of therapeutics
American journal of therapeutics PHARMACOLOGY & PHARMACY-
CiteScore
5.50
自引率
9.50%
发文量
142
审稿时长
6-12 weeks
期刊介绍: American Journal of Therapeutics is an indispensable resource for all prescribing physicians who want to access pharmacological developments in cardiology, infectious disease, oncology, anesthesiology, nephrology, toxicology, and psychotropics without having to sift through stacks of medical journals. The journal features original articles on the latest therapeutic approaches as well as critical articles on the drug approval process and therapeutic reviews covering pharmacokinetics, regulatory affairs, pediatric clinical pharmacology, hypertension, metabolism, and drug delivery systems.
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