Association of Proton Pump Inhibitor Prophylaxis on Clinical Outcome in Acute Ischemic Stroke in China: A Multicenter Retrospective Cohort Study

Abstract

Background: Overtreatment with proton pump inhibitors (PPIs) in acute ischemic stroke (AIS) patients continues to grow. We aimed to investigate the frequency of PPI prophylaxis without an appropriate indication in AIS patients in China and clarify the association between PPI prophylaxis and long-term prognosis. Methods: Based on a multicenter stroke registry database, neurological outcomes, stroke events, recurrent ischemic strokes, and all-cause death were compared between patients with and without PPI prophylaxis. Results: A total of 4542 AIS were included, and 3335 (73.4%) received PPI prophylaxis. Patients with PPI prophylaxis were more likely to have a poor outcome at 1 year than those without PPI prophylaxis (33.3% vs. 25.8%, OR 1.321; 95% CI 1.102–1.584; p = 0.003). No significant differences were found in all-cause death, stroke event, or recurrent ischemic stroke at 1 year between the two groups. After propensity score matching, PPI prophylaxis was still independently associated with a higher rate of poor outcome (30.9% vs. 25.8%, OR 1.432; 95% CI 1.151–1.780; p = 0.001). Sensitivity analysis also showed that PPI prophylaxis increased the rate of a poor outcome in minor strokes or at different durations of PPI prophylaxis. Conclusions: Approximately 3/4 of AIS patients were given PPI prophylaxis during hospitalization, which was associated with a poor long-term outcome.

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“…PPIs, H2 receptor antagonists (H2RA) and mucoprotective agents are often used to manage post-stroke heartburn symptoms or prevent gastroduodenal injury. However, the long-term use of PPIs and H2RA has been associated with unfavorable outcomes [ 6 , 51 ]. Recent studies have demonstrated that the clinically used PPIs, including omeprazole, lansoprazole, and rabeprazole, act as ligands for ChAT.…”

“…The use of antiplatelet medications in the acute phase of ischemic stroke can increase the risk of gastrointestinal bleeding [ 5 ], necessitating the careful use of gastric mucosal protective drugs. However, a multicenter retrospective study involving 4542 patients with acute ischemic stroke has revealed that 73.4 % of the patients who received proton pump inhibitors (PPIs) for either prevention or treatment had poor long-term outcomes [ 6 ].…”