Aws Almufleh1,2,3, F Daniel Ramirez1,2,4, Derek So1,2, Michel Le May1,2, Aun-Yeong Chong1,2, Nazi Torabi5, Benjamin Hibbert1,2,6,7. 1. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 2. CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 3. Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia. 4. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. 5. Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Québec, Canada. 6. Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 7. Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Abstract
OBJECTIVES: Mitigating the gastrointestinal (GI) bleeding risks of dual antiplatelet therapy (DAPT) is a common clinical concern. While proton pump inhibitors (PPIs) remain the most effective therapy, their adverse events warrant considering alternatives, including Histamine 2 receptor antagonists (H2RAs). METHODS: We searched for randomized controlled trials in MEDLINE, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials, published from 1980 to 2016. After screening, 10 trials were eligible. We compared PPIs to H2RAs in patients on DAPT in terms of 2 clinical and one laboratory outcomes; GI complications, major adverse cardiovascular events (MACE) and high on-treatment platelet reactivity (HTPR). Clinical and statistical inter-study heterogeneity was low for all 3 outcomes (I2 = 0%, p > 0.05 for all). RESULTS: Fixed effects meta-analysis suggested that PPIs were superior to H2RAs in preventing GI complications (OR 0.28, 95% CI 0.17-0.48) but with higher risk of HTPR (OR 1.28, 95% CI 1.030-1.60) though without a higher incidence of MACE (OR 0.99, 95% CI 0.55-1.77). CONCLUSIONS: PPIs are superior to H2RAs for gastroprotection in patients on DAPT. However, PPIs are associated with HTPR, with no significant difference demonstrated in MACE. Based on currently available data, the use of PPIs may be warranted in selected patients on DAPT deemed at risk for GI complications.
OBJECTIVES: Mitigating the gastrointestinal (GI) bleeding risks of dual antiplatelet therapy (DAPT) is a common clinical concern. While proton pump inhibitors (PPIs) remain the most effective therapy, their adverse events warrant considering alternatives, including Histamine 2 receptor antagonists (H2RAs). METHODS: We searched for randomized controlled trials in MEDLINE, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials, published from 1980 to 2016. After screening, 10 trials were eligible. We compared PPIs to H2RAs in patients on DAPT in terms of 2 clinical and one laboratory outcomes; GI complications, major adverse cardiovascular events (MACE) and high on-treatment platelet reactivity (HTPR). Clinical and statistical inter-study heterogeneity was low for all 3 outcomes (I2 = 0%, p > 0.05 for all). RESULTS: Fixed effects meta-analysis suggested that PPIs were superior to H2RAs in preventing GI complications (OR 0.28, 95% CI 0.17-0.48) but with higher risk of HTPR (OR 1.28, 95% CI 1.030-1.60) though without a higher incidence of MACE (OR 0.99, 95% CI 0.55-1.77). CONCLUSIONS: PPIs are superior to H2RAs for gastroprotection in patients on DAPT. However, PPIs are associated with HTPR, with no significant difference demonstrated in MACE. Based on currently available data, the use of PPIs may be warranted in selected patients on DAPT deemed at risk for GI complications.
Authors: Sean van Diepen; Tim Coulson; Xiaoming Wang; Dawn Opgenorth; Danny J Zuege; Jo Harris; Malik Agyemang; Daniel J Niven; Rinaldo Bellomo; Stephen E Wright; Paul J Young; Sean M Bagshaw Journal: Eur J Cardiothorac Surg Date: 2022-07-11 Impact factor: 4.534
Authors: Michał Wiciński; Bartosz Malinowski; Oskar Puk; Karol Górski; Dawid Adamkiewicz; Grzegorz Chojnacki; Maciej Walczak; Eryk Wódkiewicz; Monika Szambelan; Paulina Adamska; Kamila Skibińska; Maciej Socha; Maciej Słupski; Katarzyna Pawlak-Osińska Journal: Biomed Res Int Date: 2019-10-17 Impact factor: 3.411