Systematic Review and Meta-analysis: The Effects of Prophylactic Proton Pump Inhibitor Treatment in Patients With Coronary Heart Disease Receiving Dual Antiplatelet Therapy

Li, Yang; Ren, Xingshu; Fang, Zhenfei

doi:10.1097/fjc.0000000000001014

Cited by 12 publications

(12 citation statements)

References 71 publications

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“…The results showed that PPI coadministration decreased the risk of GI complications but could increase the rates of MACEs, stroke, revascularization and ST, in line with previous studies ( Melloni et al, 2015 ; Hu et al, 2018 ). There were also no significant differences in the risks of all-cause mortality and cardiac death ( Hu et al, 2018 ; Li et al, 2021 ; Melloni et al, 2015 ).…”

Section: Discussionmentioning

confidence: 90%

“…However, the existing clinical studies of the association between cardiovascular events and the concomitant use of PPIs with aspirin-clopidogrel DAPT in CHD have been conflicting ( Ben Ghezala et al, 2022 ). Some meta-analyses were conducted to assess the clinical significance of this interaction and found that coadministration of PPIs could increase the rates of major adverse cardiovascular events (MACEs), stroke, revascularization, and stent thrombosis (ST) but not myocardial infarction (MI), all-cause mortality, or cardiac death ( Guo et al, 2021 ; Hu et al, 2018 ; Li et al, 2021 ; Melloni et al, 2015 ; Sherwood et al, 2015 ). Interestingly, two recent clinical studies reported that the rates of MI, all-cause mortality and cardiac death were significantly increased in PPI users compared to non-users ( Maret-Ouda et al, 2021 ; Mohammed et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of concomitant use of proton pump inhibitors with aspirin-clopidogrel dual antiplatelet therapy in coronary heart disease: A systematic review and meta-analysis

Luo

et al. 2023

Front. Pharmacol.

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Background: Proton pump inhibitors (PPIs) are usually prescribed to prevent gastrointestinal (GI) complications in patients receiving dual antiplatelet therapy (DAPT). This systematic review and meta-analysis aimed to explore the efficacy and safety of the concomitant use of PPIs with aspirin-clopidogrel DAPT in patients with Coronary heart disease (CHD).Method: The PubMed, Embase, Cochrane Library, and Web of Science databases were searched from inception to August 2022 for eligible studies. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to evaluate the clinical outcomes. Subgroup analysis was conducted according to different PPI subtypes, populations, follow-up times and study types. This study was registered on PROSPERO (CRD42022332195).Results: A total of 173,508 patients from 18 studies [2 randomized controlled trials (RCTs), 3 post hoc analyses of RCTs, and 13 cohort studies] were included in this study. Pooled data revealed that coadministration of PPIs significantly increased the risk of major adverse cardiovascular events (MACEs) (HR = 1.15, 95% CI = 1.06–1.26, p = .001) and reduced the risk of gastrointestinal (GI) complications (HR = 0.44, 95% CI = 0.30–0.64, p < .0001). Subgroup analysis results showed that the esomeprazole users and patients with coronary stenting in the PPI group were associated with an increased risk of MACEs compared with the non-PPI group. The occurrence of MACEs in PPI users was more common than that in non-PPI users in long-term follow-up (≥12 months) studies and in the observational studies. There was no significant differences in the incidences of net clinical adverse events (NACEs), all-cause mortality, or cardiac death between the two groups.Conclusion: In patients with CHD, the concomitant use of PPIs with aspirin and clopidogrel was associated with a reduced risk of GI complications but could increase the rates of MACEs (particularly in patients receiving esomeprazole or with coronary stenting). There was no clear evidence of an association between PPI use and NACEs, all-cause mortality, or cardiac death. The results could have been affected by the follow-up time and study type. Further large-scale RCTs with long-term follow-up are needed.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of concomitant use of proton pump inhibitors with aspirin-clopidogrel dual antiplatelet therapy in coronary heart disease: A systematic review and meta-analysis

Luo

et al. 2023

Front. Pharmacol.

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“…Compared with non-PPIs arm, the PPIs arm reduced the risk of GI complications. 16 Similar views were reported in both meta-analyses. However, there are some differences in our meta-analysis.…”

Section: Discussionmentioning

confidence: 98%

“…Previous meta-analyses evaluated the strategy of PPIs combined with aspirin and P2Y 12 receptor inhibitors, but the results were inconsistent. 6,[15][16][17] Meanwhile, with the update of guidelines, more antithrombotic strategies have been proposed. We performed this meta-analysis and hypothesized that PPIs plus antithrombotic strategy can reduce the risk of GI bleeding without increasing ischemic events in patients with CAD.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Proton Pump Inhibitors in Patients With Coronary Artery Diseases Receiving Oral Antiplatelet Agents and/or Anticoagulants: A Systematic Review and Meta-Analysis

Shang

Zhong

et al. 2022

Journal of Cardiovascular Pharmacology

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“…This may be particularly relevant to the acute setting. Observational studies have suggested some interaction effects between proton pump inhibitors and DAPT, with a high degree of heterogeneity [94]. While the only large-scale RCT on the prophylactic use of proton pump inhibitors in patients receiving clopidogrel demonstrated reduced upper gastrointestinal bleeding without increasing ischemic risks [95,96], guidelines vary in terms of patient selection for such prophylactic use [97].…”

Section: Common P2y 12 I Drug Interactionsmentioning

confidence: 99%

Antiplatelet Therapy Aims and Strategies in Asian Patients with Acute Coronary Syndrome or Stable Coronary Artery Disease

Tam

Tse

2022

JCM

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Dual antiplatelet therapy (DAPT) has been the mainstay treatment to reduce ischemic events, such as myocardial infarction or stroke, in patients with coronary artery disease (CAD). The development of potent P2Y12 inhibitors (ticagrelor and prasugrel) has helped to further reduce ischemic events, particularly among high-risk patients. Meanwhile, the evolution of newer generations of drug-eluting stents are also improving outcomes of percutaneous coronary intervention. Research studies on antiplatelet therapy in recent years have focused on balancing ischemic and bleeding risks through different strategies, which include P2Y12 inhibitor monotherapy, escalation and de-escalation, and extended DAPT. Because results from the large number of clinical studies may sometimes appear conflicting, this review aims to summarize recent advances, and demonstrate that they are aligned by a general principle, namely, strategies may be adopted based on treatment aims for specific patients at several time points. Another aim of this review is to outline the important considerations for using antiplatelet therapy in Asian patients, in whom there is a greater prevalence of CYP2C19 loss-of-function mutations, and a common increased risk of bleeding, despite high platelet reactivity (the so-called “East Asian Paradox”).

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Systematic Review and Meta-analysis: The Effects of Prophylactic Proton Pump Inhibitor Treatment in Patients With Coronary Heart Disease Receiving Dual Antiplatelet Therapy

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 12 publications

References 71 publications

Efficacy and safety of concomitant use of proton pump inhibitors with aspirin-clopidogrel dual antiplatelet therapy in coronary heart disease: A systematic review and meta-analysis

Efficacy and safety of concomitant use of proton pump inhibitors with aspirin-clopidogrel dual antiplatelet therapy in coronary heart disease: A systematic review and meta-analysis

Efficacy and Safety of Proton Pump Inhibitors in Patients With Coronary Artery Diseases Receiving Oral Antiplatelet Agents and/or Anticoagulants: A Systematic Review and Meta-Analysis

Antiplatelet Therapy Aims and Strategies in Asian Patients with Acute Coronary Syndrome or Stable Coronary Artery Disease

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