Proton-pump inhibitors for the prevention of upper gastrointestinal bleeding in adults receiving antithrombotic therapy

Causada‐Calo, Natalia; Germini, Federico; Yuan, Yuhong; Eikelboom, John W.; Martin, Paul

doi:10.1002/14651858.cd013415

Cited by 4 publications

(4 citation statements)

References 44 publications

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“…Of note, a Cochrane review is currently under way to assess the benefits and harms of PPIs vs histamine-2 receptor antagonists or placebo for the prevention of upper GI bleeding in adults receiving single-agent and combination antithrombotic therapy for cardiovascular conditions. 420…”

Section: Oac Resumptionmentioning

confidence: 99%

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

Andrade

Aguilar

Atzema

et al. 2020

Canadian Journal of Cardiology

425

496

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The Canadian Cardiovascular Society (CCS) atrial fibrillation (AF) guidelines program was developed to aid clinicians in the management of these complex patients, as well as to provide direction to policy makers and health care systems regarding related issues. The most recent comprehensive CCS AF guidelines update was published R ESUM ELe programme de lignes directrices de la Soci et e canadienne de cardiologie (SCC) en matière de fibrillation auriculaire (FA) a et e elabor e pour aider les cliniciens à prendre en charge ces patients complexes, ainsi que pour orienter les d ecideurs politiques et les systèmes de soins de sant e sur des questions connexes. La dernière edition

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Section: Oac Resumptionmentioning

confidence: 99%

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

Andrade

Aguilar

Atzema

et al. 2020

Canadian Journal of Cardiology

425

496

View full text Add to dashboard Cite

show abstract

“…Gastroprotection therapy should be routinely recommended for older patients receiving multiple antithrombotic agents or those with other UGIB risk factors. 37 , 38 Finally, it was observed that woemn were significantly less likely to receive DAT, even when all other patient-related factors were accounted for; possible undertreatment of females warrants further study.…”

Section: Discussionmentioning

confidence: 85%

Dual antithrombotic therapy and gastroprotection in atrial fibrillation: an observational primary care study

Xie

Robson²,

Williams³

et al. 2022

BJGP Open

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BackgroundPatients with both atrial fibrillation (AF) and cardiovascular disease (CVD) may receive dual-antithrombotic therapy (DAT) with both an anticoagulant and one or more antiplatelet agents. Avoiding prolonged duration of therapy and use of gastroprotective therapies reduces bleeding risk.AimTo describe the extent and duration of DAT and use of gastroprotection in a primary care cohort of patients with AF.Design & settingObservational study in 1.2 million people registered with general practitioners across four east London Clinical Commissioning Groups, covering prescribing from January 2020 to June 2021.MethodIn patient with AF, we characterised factors associated with DAT prescription, prolonged DAT prescription (>12 months), and gastroprotective prescription using logistic regression.ResultsThere were 8,881 patients with AF of whom 4.7% (416) were on DAT. Of these, 65.9% (274) were prescribed DAT for >12 months and 84.0% (351) were prescribed concomitant gastroprotection. Independent of all other factors, women with AF were less likely to receive DAT than men [OR =0.61 (0.49–0.77)]. Similarly, older (≥75 years) individuals [OR =0.79 (0.63–0.98)]) were less likely to receive DAT than younger patients. Amongst those with AF on DAT, people with CVD [OR =3.33 (1.71–6.47)] or South Asian ethnicity [OR =2.70 (1.15–6.32)] were associated with increased gastroprotection prescriptions. Gastroprotection prescription [OR =1.80 (1.01–3.22)] was associated with prolonged DAT prescription.ConclusionAlmost two thirds of patients with AF on DAT were prescribed prolonged durations of therapy. Prescription of gastroprotection therapies was suboptimal in 1 in 6 patients. Treatment decisions varied by sex, age, ethnicity, and comorbidity. Duration of DAT and gastroprotection in patients with AF requires improvement.

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“…PPIs also prevented symptomatic and endoscopic ulcers in patients taking NSAIDs with an NNT of 20 and 5, respectively [85,86]. A systematic review [87,88] of 5 RCTs involving over 5000 participants also reported that PPIs are effective in reducing PU bleeding related to clopidogrel-based antithrombotic therapy. There was a 66% reduction in PU bleed in patients allocated to PPI compared to placebo or famotidine with an NNT of 60 [88].…”

Section: Proton Pump Inhibitor Therapymentioning

confidence: 99%

“…There are also concerns that PPI may interact with clopidogrel reducing efficacy [110•] and this could not be addressed in the COMPASS trial as patients had to discontinue this drug. A systematic review of RCTs [87,88] did not find any difference in cardiovascular events in the PPI arm compared to the placebo/famotidine arms in patients taking clopidogrel suggesting that the results of observational data probably relate to residual confounding. These data suggest that the benefits of PPI therapy outweigh any putative risk provided the appropriate patients are selected for gastroprotection.…”

Section: Proton Pump Inhibitor Therapymentioning

confidence: 99%

Who Needs Gastroprotection in 2020?

Kanno

Martin

2020

Curr Treat Options Gastro

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Proton-pump inhibitors for the prevention of upper gastrointestinal bleeding in adults receiving antithrombotic therapy

Cited by 4 publications

References 44 publications

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

Dual antithrombotic therapy and gastroprotection in atrial fibrillation: an observational primary care study

Who Needs Gastroprotection in 2020?

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