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      Comparison of prophylactic effect of UGIB and effects on platelet function between PPIs and H 2RAs combined with DAPT: systematic review and meta-analysis

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          Abstract

          Objective

          We compared prophylactic effects of proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H 2RAs) on upper gastrointestinal bleeding (UGIB) associated with dual antiplatelet therapy (DAPT) and explored this influence on platelet function.

          Methods

          Randomized controlled trials and cohort studies comparing PPIs with H 2RAs in adults receiving DAPT were collected from PubMed, EMBASE and Cochrane databases. Dichotomous data were pooled to obtain risk ratios (RRs) for UGIB, major adverse cardiovascular events (MACEs), poor responders to clopidogrel and rehospitalization, and continuous data were pooled to obtain mean differences (MDs) for P2Y 12 reaction units (PRUs), with 95% confidence intervals (CIs).

          Results

          Twelve clinical trials (n=3,301) met the inclusion criteria. Compared to H 2RAs, PPIs lessened UGIB (RR =0.16, 95% CI: 0.03–0.70), and there was no significant difference in the incidence of PRUs (MD =18.21 PRUs, 95% CI: −4.11–40.54), poor responders to clopidogrel (RR =1.21, 95% CI: 0.92–1.61), incidence of MACEs (RR =0.89, 95% CI: 0.45–1.75) or rehospitalization (RR =1.76, 95% CI: 0.79–3.92). Subgroup analysis confirmed fewer PRUs in the H 2RAs group compared to the omeprazole group (2 studies, n=189, MD =31.80 PRUs, 95% CI: 11.65–51.96). However, poor responder data for clopidogrel and MACEs might be unreliable because few studies of this kind were included.

          Conclusion

          Limited evidence indicates that PPIs were better than H 2RAs for prophylaxis of UGIB associated with DAPT and had no effect on platelet function. Further study is needed to confirm these observations.

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          Most cited references 32

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          ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents.

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            ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use.

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              • Record: found
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              • Article: not found

              Proton pump inhibitors in prevention of low-dose aspirin-associated upper gastrointestinal injuries.

              To determine the preventive effect and safety of proton pump inhibitors (PPIs) in low-dose aspirin (LDA)-associated gastrointestinal (GI) ulcers and bleeding.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2017
                24 March 2017
                : 13
                : 367-377
                Affiliations
                [1 ]Department of Pharmacy, Peking University Third Hospital, Beijing
                [2 ]Department of Pharmacy, China Pharmaceutical University, Nanjing, People’s Republic of China
                [3 ]Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
                Author notes
                Correspondence: Suo-Di Zhai, Department of Pharmacy, Peking University Third Hospital, No 49 North Garden Road, Haidian District, Beijing 100191, People’s Republic of China, Tel +86 10 8226 6686, Fax +86 10 8226 5740, Email zhaisuodi@ 123456163.com
                Article
                tcrm-13-367
                10.2147/TCRM.S127292
                5373835
                © 2017 Yi et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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