Appropriateness of gastrointestinal prophylaxis use during hospitalization in patients with acute myocardial infarction: Analysis from the China Acute Myocardial Infarction Registry

Shi, Wankai; Ni, Lin; Yang, Jia; Fan, Xiaoxue; Yu, Mei‐Ching; Yang, Hongmei; Yu, Mengyue; Yang, Yuejin

doi:10.1002/clc.23449

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…We noticed that PPI over-prescription was becoming a new concern in the field of AMI patient management ( 9 , 10 ). And our former research also emphasized this in the Chinese AMI population ( 12 ). Although our study focused on patients with low GIB risk, the PPI use rate (66%) was still higher than that in the ADAPT-DES study ( 13 ) (31.4%), PRODIGY trial ( 14 ) (37.4%), and TRANSLATE-ACS study ( 15 ) (18.2%).…”

Section: Discussionmentioning

confidence: 74%

The Clinical Impact of Proton Pump Inhibitors When Co-Administered With Dual Antiplatelet Therapy in Patients Having Acute Myocardial Infarction With Low Risk of Gastrointestinal Bleeding: Insights From the China Acute Myocardial Infarction Registry

Shi¹,

Yang³

et al. 2021

Front. Cardiovasc. Med.

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Background: The latest guidelines recommend the use of proton pump inhibitors (PPIs) to minimize gastrointestinal bleeding (GIB) in patients receiving dual antiplatelet therapy (DAPT), even though this co-administration may increase the risk of ischemia due to drug interactions. We have noticed that there are few studies conducted on patients with a lower risk of GIB. Therefore, we investigated the clinical effect of co-administration of PPI on DAPT patients with low GIB risk.Methods and Results: From January 2013 to September 2014, a total of 17,274 consecutive patients on DAPT from 108 hospitals with low risk for GIB in the China Acute Myocardial Infarction (CAMI) registry were analyzed. The primary endpoints were GIB and major adverse cardiovascular and cerebrovascular events (MACCE). Multivariate logistic regression analysis and Cox proportional hazard models were used to assess the effect of PPIs use. Of the analyzed patients, 66.6% (n = 11,487) were treated with PPIs. PPI use did not show an extra gastrointestinal protective effect in patients with low risk for GIB who were hospitalized and on follow-up after 2 years. Moreover, it was associated with an increased risk of stroke during the 2-year follow-up [hazard ratio (HR) 2.072, 95% confidence interval (CI) 1.388–3.091, p = 0.0003] and an increased risk of MI after 6 months (HR 1.580, 95% CI 1.102–2.265, p = 0.0119). We found the same results after propensity score matching.Conclusion: PPI use is prevalent in DAPT patients with low GIB risk. PPIs did not show an extra gastrointestinal protective effect, while an increased risk of stroke was observed during the 2-year follow-up.Clinical Trial Registration:www.clinicaltrials.gov, identifier NCT01874691.

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Section: Discussionmentioning

confidence: 74%

The Clinical Impact of Proton Pump Inhibitors When Co-Administered With Dual Antiplatelet Therapy in Patients Having Acute Myocardial Infarction With Low Risk of Gastrointestinal Bleeding: Insights From the China Acute Myocardial Infarction Registry

Shi¹,

Yang³

et al. 2021

Front. Cardiovasc. Med.

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“…It should be noted that although PPIs are used to reduce gastrointestinal outcomes such as gastrointestinal ulcers and upper gastrointestinal bleeding in high-risk patients [ 39 ], lower gastrointestinal complications might arise due to PPI use [ 40 ]. The first three months is the high-risk period for both upper and lower gastrointestinal hemorrhage in PCI patients undergoing DAPT, and the incidence of lower gastrointestinal hemorrhage is higher than that of upper gastrointestinal bleeding [ 41 ]. According to researchers, short-term (six months) DAPT followed by P2Y12 inhibitor monotherapy can lower the incidence of severe hemorrhage after PCI without elevating the risk of AMI [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Proton Pump Inhibitors Combining Dual Antiplatelet Therapy in Patients with Coronary Intervention: A Systematic Review, Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

Liang¹,

Ma²,

Chen³

et al. 2023

Rev. Cardiovasc. Med.

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Background: Proton pump inhibitors (PPIs) are used to prevent gastrointestinal hemorrhage in patients with coronary treatment undergoing dual antiplatelet therapy (DAPT). Methods: A systematic review was performed to compare the outcomes between DAPT and DAPT + PPI in acute coronary syndrome (ACS) patients or patients who took percutaneous coronary intervention (PCI) with coronary stent implantation (PCI patients), and to estimate, for the first time, the sample size needed for reliable results via trial sequential analysis (TSA). The PubMed, EMBASE, the Cochrane Library and Web of Science databases were searched for articles authored from the onset until November 1, 2022, for randomized controlled trials (RCTs) comparing outcomes in ACS or PCI patients who undertook DAPT or DAPT + PPI. The primary outcomes were the incidence rate of gastrointestinal events and major adverse cardiovascular events (MACEs). Results: The initial web search retrieved 786 literature references. Eventually, eight articles published between 2009 and 2020 were incorporated into the systematic review and meta-analysis. The combined results established a non-significant variation in MACEs incidences between the DAPT group and DAPT + PPI group [risk ratio (RR) = 0.93, 95% confidence interval (CI) = 0.81–1.06, p = 0.27, = 0%]; conversely, the incidence of gastrointestinal events was significantly decreased in the DAPT + PPI group in comparison with the DAPT group (RR = 0.33, 95% CI = 0.24–0.45, p 0.00001, = 0%). TSA of MACEs and gastrointestinal events revealed that meta-analysis included adequate trials (required sample size = 6874) in the pool to achieve 80% study power. Conclusions: Based on our results, DAPT + PPI can significantly reduce gastrointestinal outcomes without affecting cardiovascular outcomes in PCI and ACS patients compared to DAPT.

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“…The mechanisms behind the high rates of mortality and nonfatal myocardial infarction in patients with ACS experiencing GIB are multifactorial. These patients have a more unfavourable baseline clinical profile that include older age, higher prevalence of diabetes, anaemia and chronic renal insufficiency, all factors known to worsen the prognosis of patients with ACS 8 11 12…”

Section: Introductionmentioning

confidence: 99%

Improving use of proton pump inhibitors with dual antiplatelet therapy in patients admitted with acute coronary syndrome

2022

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Acute coronary syndrome (ACS) is one of the leading causes of morbidity and mortality with a major impact on healthcare resources and expenditure. Dual antiplatelet therapy (DAPT) is recommended for the treatment of ACS. DAPT is associated with an increased risk of gastrointestinal (GI) bleeding, which is seen in 1.2%–2.4% of patients on DAPT and associated with fivefold increase in mortality at 30 days and fourfold increase at 1 year. European Society of Cardiology guidelines recommend that patients on DAPT should also be prescribed a proton pump inhibitor (PPI) to reduce the risk of GI bleeding.We assessed compliance with this recommendation on the cardiology ward of our tertiary cardiac unit. At baseline, only 56% of patients on DAPT were coprescribed a PPI. We subsequently devised and delivered a service improvement project (three completed audit cycles) to improve concomitant prescription of PPI, with the aim of achieving 100% compliance with the guidelines. We introduced low-cost interventions that included educational sessions for junior doctors, cardiac nursing staff and pharmacists, as well as posters which served as visual prompts for discharging doctors. We also initiated a protocol that the pharmacy team clarify with the discharging doctor whether a patient on DAPT should also be on PPI, before the discharge summary is finalised.Consequently, 100% of patients on DAPT were coprescribed PPI within fourteen weeks of the onset of our intervention. This improvement was sustained across a subsequent cohort of junior doctors. Our interventions should help to reduce the risk of GI bleeding in this population.

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Appropriateness of gastrointestinal prophylaxis use during hospitalization in patients with acute myocardial infarction: Analysis from the China Acute Myocardial Infarction Registry

Cited by 3 publications

References 27 publications

The Clinical Impact of Proton Pump Inhibitors When Co-Administered With Dual Antiplatelet Therapy in Patients Having Acute Myocardial Infarction With Low Risk of Gastrointestinal Bleeding: Insights From the China Acute Myocardial Infarction Registry

The Clinical Impact of Proton Pump Inhibitors When Co-Administered With Dual Antiplatelet Therapy in Patients Having Acute Myocardial Infarction With Low Risk of Gastrointestinal Bleeding: Insights From the China Acute Myocardial Infarction Registry

The Efficacy and Safety of Proton Pump Inhibitors Combining Dual Antiplatelet Therapy in Patients with Coronary Intervention: A Systematic Review, Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

Improving use of proton pump inhibitors with dual antiplatelet therapy in patients admitted with acute coronary syndrome

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