Hiccups commonly occur in patients undergoing chemotherapy for lung cancer and may diminish their motivation for treatment. Therefore, it is important to characterize the hiccups and their risk factors. We examined the medical records of 120 patients with lung cancer during their initial chemotherapy and extracted data on the patients' profiles and the onset, duration, and severity of their hiccup episodes. We found the incidence of hiccups to be 19.2% among the patients. Hiccups appeared within 3 days of beginning the chemotherapy and disappeared within 4 days. Hiccups hindered sleep in two patients. The characteristics of the hiccups episodes in our study were not different from those of previous studies. We also investigated distinctive features of the patients who developed hiccups. The occurrence of hiccups was associated with gender, age, and the treatment with platinum agents. Antiemetic agents, dexamethasone and neurokinin-1 receptor antagonists, also showed significant effects on hiccup episodes. Although the dose-responsive effect of dexamethasone on hiccups was insignificant and the effects of two neurokinin-1 receptor antagonists, aprepitant and fosaprepitant, on hiccups appeared identical. From these results, we suggest that a high incidence of hiccups may be anticipated with a prophylactic use of antiemetic agents, dexamethasone and neurokinin-1 receptor antagonists.
Proton pump inhibitors (PPI) are frequently used to prevent upper gastrointestinal bleeding (UGIB) in patients receiving dual-antiplatelet therapy (DAPT) with aspirin and clopidogrel. However, the concomitant therapy of PPI and DAPT has been associated with a decreased effect of the antiplatelet drugs and an increased risk of major adverse cardiovascular events (MACE). It has been suggested that histamine H2 receptor antagonists (H2RA) can be used as alternatives to PPI to prevent UGIB during DAPT without an increase in the risk of MACE. We tested this hypothesis in a retrospective cohort study including patients without a prior history of upper gastrointestinal events. We examined the incidence of UGIB and MACE in 296 patients treated with H2RA (H2RA group) and 447 patients not treated with H2RA (control group) during DAPT with aspirin and clopidogrel after drug-eluting stent implantation. The patients treated with PPI were excluded. In the 1-year follow-up, UGIB occurred in 2 patients (0.7%) in the H2RA group and 12 (2.7%) in the control group. The incidence of UGIB was significantly different between the two groups (p = 0.049 in log-rank test). MACE occurred in 31 patients (10.5%) in the H2RA group and in 54 patients (12.1%) in the control group, and the incidence was not significantly different (p = 0.447 in logrank test). Thus, H2RA may be effective safe alternatives to PPI during DAPT in patients without a prior history of upper gastrointestinal events.
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