Systematic review with meta‐analysis: the association between the use of calcium channel blockers and gastrointestinal bleeding

He, Ying; Chan, Esther W.; Leung, Wai K.; Anand, Shweta; Wong, Ian C. K.

doi:10.1111/apt.13211

Cited by 14 publications

(12 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies with one star for comparability only controlled for age and gender in the analysis whereas studies with two stars under comparability also controlled for other important variables such as body mass index, comorbidity, laboratory tests or use of other relevant drugs. A final score ≥ seven was considered as high quality[22].…”

Section: Methodsmentioning

confidence: 99%

Effect of evidence-based therapy for secondary prevention of cardiovascular disease: Systematic review and meta-analysis

Ma¹,

Wong

Man

et al. 2019

PLoS ONE

View full text Add to dashboard Cite

BackgroundThe combination pharmacotherapy of antiplatelet agents, lipid-modifiers, ACE inhibitors/ARBs and beta-blockers are recommended by international guidelines. However, data on effectiveness of the evidence-based combination pharmacotherapy (EBCP) is limited.ObjectivesTo determine the effect of EBCP on mortality and Cardiovascular events in patients with Coronary Heart Disease (CHD) or cerebrovascular disease.MethodsPublications in EMBASE and Medline up to October 2018 were searched for cohort and case-control studies on EBCP for the secondary prevention of cardiovascular disease. The main outcomes were all-cause mortality and major cardiovascular events. Meta-analyses were performed based on random effects models.Results21 studies were included. Comparing EBCP to either monotherapy or no therapy, the pooled risk ratios were 0.60 (95% confidence interval 0.55 to 0.66) for all-cause mortality, 0.70 (0.62 to 0.79) for vascular mortality, 0.73 (0.64 to 0.83) for myocardial infarction and 0.79 (0.68 to 0.91) for cerebrovascular events. Optimal EBCP (all 4 classes of drug prescribed) had a risk ratio for all-cause mortality of 0.50 (0.40 to 0.64). This benefit became more dilute as the number of different classes of drug comprising EBCP was decreased—for 3 classes of drug prescribed the risk ratio was 0.58 (0.49 to 0.69) and for 2 classes, the risk ratio was 0.67 (0.60 to 0.76).ConclusionsEBCP reduces the risk of all-cause mortality and cardiovascular events in patients with CHD or cerebrovascular disease. The different classes of drugs comprising EBCP work in an additive manner, with optimal EBCP conferring the greatest benefit.

show abstract

Section: Methodsmentioning

confidence: 99%

Effect of evidence-based therapy for secondary prevention of cardiovascular disease: Systematic review and meta-analysis

Ma¹,

Wong

Man

et al. 2019

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…This scale provides specific criteria to assess the study selection (four items), comparability (two items) and ascertainment of exposure/outcome (three items). The ‘high’‐quality items were scored with an asterisk and the maximum score was nine; this scale has been used in many published meta‐analyses . A final score ≥7 was considered to represent high quality.…”

Section: Methodsmentioning

confidence: 99%

The association between non‐vitamin K antagonist oral anticoagulants and gastrointestinal bleeding: a meta‐analysis of observational studies

Wong

Xue

et al. 2016

Brit J Clinical Pharma

View full text Add to dashboard Cite

Particular concerns have been raised regarding the association between non-vitamin K antagonist oral anticoagulants (NOACs) and the risk of gastrointestinal bleeding (GIB); however, current findings are still inconclusive. We conducted a systematic review with a meta-analysis to examine the association between NOACs and GIB in real-life settings. We performed a systematic search of PubMed, EMBASE and CINAHL Plus up to September 2015. Observational studies that evaluated exposure to NOACs reporting GIB outcomes were included. The inverse variance method using the random-effects model was used to calculate the pooled estimates. Eight cohort studies were included in the primary meta-analysis, enrolling 1442 GIB cases among 106 626 dabigatran users (49 486 patient-years), and 184 GIB cases among 10 713 rivaroxaban users (4046 patient-years). The pooled incidence rates of GIB were 4.50 [95% confidence interval (CI) 3.17, 5.84] and 7.18 (95% CI 2.42, 12.0) per 100 patient-years among dabigatran and rivaroxaban users, respectively. The summary risk ratio (RR) was 1.21 (95% CI 1.05, 1.39) for dabigatran compared with warfarin, and 1.09 (95% CI 0.92, 1.30) for rivaroxaban. Subgroup analyses showed a dose-related effect of dabigatran, with a significantly higher risk of GIB for 150 mg b.i.d. (RR = 1.51, 95% CI 1.34, 1.70) but not for 75 mg b.i.d. or 110 mg b.i.d.. In addition, the use of proton pump inhibitors (PPIs)/histamine H2-receptor antagonists (H2RAs) influenced the association in dabigatran users, whereas this effect was modest among rivaroxaban users. In conclusion, our meta-analysis suggested a slightly higher risk of GIB with dabigatran use compared with warfarin, whereas no significant difference was found between rivaroxaban and warfarin for GIB risk.

show abstract

“…A recent meta-analysis [23] has shown a small association between CCB treatment and risk of gastrointestinal bleeding. However, these observations provide a likely explanation for the decreased iron levels in our study.…”

Section: Discussionmentioning

confidence: 99%

“…As this study seems to be the first to indicate an association between CCBs and anemia risk in patients with heart failure, the specific mechanism behind these findings is yet to be determined. Possible explanations include EPO resistance determined by blocking the cellular calcium influx [22], gastrointestinal bleeding [23], and/or impaired iron absorption through intestinal cell by reduced DMT–1expression [25].…”

Section: Discussionmentioning

confidence: 99%

The Influence of Cardiovascular Medications on Iron Metabolism in Patients with Heart Failure

Sîrbu

Șorodoc

Jaba³

et al. 2019

Medicina

View full text Add to dashboard Cite

Background and objectives: The etiology of anemia associated with heart failure is not fully understood, but there are data suggesting the involvement of multiple mechanisms, including various drug therapies used in patients with heart failure. Our primary objective was to evaluate the impact of beta blockers, angiotensin-converting enzyme inhibitors, and calcium-channel blockers on iron metabolism in patients with heart failure. Materials and Methods: This was a prospective observational study that included patients diagnosed with heart failure and iron deficiency (defined by ferritin <100 μg/L, or 100–300 μg/L with transferrin saturation <20%). Patients with anemia secondary to a known cause were excluded. Results: We found a statistically significant correlation between beta-blocker treatment and ferritin values (p = 0.02). Iron, hemoglobin, and hematocrit levels were significantly lower in the patients using calcium-channel blockers than those who were not. We also found a statistically significant indirect correlation (p = 0.04) between the use of angiotensin-converting enzyme inhibitors and hematocrit levels. Conclusion: The contribution of our study arises from the additional data regarding the drug-induced etiology of iron deficiency. Practitioners should be aware of the potential impact of therapeutic recommendations and this should imply a close monitoring of the biochemical parameters of iron deficiency in this category of patients.

show abstract

Systematic review with meta‐analysis: the association between the use of calcium channel blockers and gastrointestinal bleeding

Abstract: SUMMARY BackgroundDue to their potential anti-platelet effect, it is suggested that calcium channel blockers (CCBs) are associated with gastrointestinal bleeding (GIB). However, results from previous studies are conflicting.

Cited by 14 publications

References 46 publications

Effect of evidence-based therapy for secondary prevention of cardiovascular disease: Systematic review and meta-analysis

Effect of evidence-based therapy for secondary prevention of cardiovascular disease: Systematic review and meta-analysis

The association between non‐vitamin K antagonist oral anticoagulants and gastrointestinal bleeding: a meta‐analysis of observational studies

The Influence of Cardiovascular Medications on Iron Metabolism in Patients with Heart Failure

Contact Info

Product

Resources

About