Meta-Analysis of Efficacy and Safety of Proton Pump Inhibitors with Dual Antiplatelet Therapy for Coronary Artery Disease

Khan, Safi U.; Lone, Ahmad Naeem; Asad, Zain Ul Abideen; Rahman, Hammad; Khan, Muhammad Shahzeb; Saleem, Muhammad A; Arshad, Adeel; Nawaz, Najma; Sattur, Sudhakar; Kaluski, Edo

doi:10.1016/j.carrev.2019.02.002

Cited by 16 publications

(9 citation statements)

References 60 publications

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“…Additional studies have corroborated the finding that PPIs reduce the risk of UGIB, GI ulcers, and erosions in patients on concurrent DAPT [36,[53][54][55][56]. Screening for risk factors of upper GI bleeding did not significantly reduce the incidence of UGIB in patients placed on DAPT and PPI [57].…”

Section: Use Of Ppi While On Daptmentioning

confidence: 87%

Co-prescription of Dual-Antiplatelet Therapy and Proton Pump Inhibitors: Current Guidelines

Saven¹,

Zhong²,

McFarlane³

2022

Cureus

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Dual-antiplatelet therapy (DAPT) prevents thrombotic complications associated with coronary artery disease, acute coronary syndrome, and stent thrombosis following the percutaneous coronary intervention or coronary artery bypass grafting. When initiating DAPT, the risk of thrombosis must be balanced with the increased risk of upper gastrointestinal bleed (UGIB). Proton-pump inhibitors (PPIs) are concurrently prescribed with DAPT to reduce bleeding risk. In this review, we discuss the benefits and potential complications of DAPT/PPI co-prescription. The only large international randomized control trial (RCT), Clopidogrel and the Optimization of Gastrointestinal Events Trial (COGENT), shows robust evidence that PPIs are a safe and effective method to reduce the risk of bleeding in patients on DAPT. However, more large-scale RCTs are needed to study potential long-term effects and draw a stronger conclusion on this topic.

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Section: Use Of Ppi While On Daptmentioning

confidence: 87%

Co-prescription of Dual-Antiplatelet Therapy and Proton Pump Inhibitors: Current Guidelines

Saven¹,

Zhong²,

McFarlane³

2022

Cureus

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“…Regarding medical therapy for preventing bleeding complications during DAPT, a proton pump inhibitor should be prescribed as it reduces upper gastrointestinal bleeding in patients with cirrhosis[ 36 , 64 ]. It is also most important to administer a maximally tolerated dose of beta-adrenergic blocking agents due to their positive effect on portal hypertension and CAD[ 28 , 65 ].…”

Section: What Are Potential Tools That Could Be Used To Assess and Lower Bleeding Risk?mentioning

confidence: 99%

Safety and efficacy of dual antiplatelet therapy after percutaneous coronary interventions in patients with end-stage liver disease

Ostojić¹,

Ostojić²,

Bulum³

et al. 2021

WJC

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The prevalence of coronary artery disease (CAD) increases in patients with end-stage liver disease, with part of them receiving the percutaneous coronary intervention (PCI) as a treatment option. Dual antiplatelet therapy (DAPT), a standard of care after PCI, could result in catastrophic consequences in this population. Before PCI and the start of DAPT, it is recommended to assess patient bleeding risk. Based on novel findings, liver cirrhosis does not necessarily lead to a significant increase in bleeding complications. Furthermore, conventional methods, such as the international normalized ratio, might not be appropriate in assessing individual bleeding risk. The highest bleeding risk among cirrhotic patients has a subgroup with severe thrombocytopenia (< 50 × 10 9 /L) and elevated portal pressure. Therefore, every effort should be made to maintain thrombocyte count above > 50 × 10 9 /L and prevent variceal bleeding. There is no solid evidence for DAPT in patients with cirrhosis. However, randomized trials investigating short (one month) DAPT duration after PCI with new drug-eluting stents (DES) in a high bleeding risk patient population can be implemented in patients with cirrhosis. Based on retrospective studies (with older stents and protocols), PCI and DAPT appear to be safe but with a higher risk of bleeding complications with longer DAPT usage. Finally, novel methods in assessing CAD severity should be performed to avoid unnecessary PCI and potential risks associated with DAPT. When indicated, PCI should be performed over radial artery using contemporary DES. Complementary medical therapy, such as proton pump inhibitors and beta-blockers, should be prescribed for lower bleeding risk patients. Novel approaches, such as thromboelastography and “preventive” upper endoscopies in PCI circumstances, warn clinical confirmation.

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“…92,93 A more recent meta-analysis, however, has shown that the use of PPIs and dual antiplatelet therapy improves outcomes of GI bleeding, without compromising cardiovascular outcomes and that further randomized trials are required in this area. 94 There are numerous alternatives to PPIs that have been trialed with various degrees of success. Histamine-2 receptor antagonists (H 2 RAs), such as ranitidine, nizatidine, famotidine, and cimetidine, although historically the first-line therapy, are less effective than PPIs in symptom control and esophageal healing and are often used as the step-down therapy or as an adjunct to PPIs.…”

Section: Medical Therapymentioning

confidence: 99%

“…In some studies, it has been suggested that PPIs block the conversion of the prodrug clopidogrel to its active form by preferentially utilizing the cytochrome P450 enzymes within the liver 92,93 . A more recent meta‐analysis, however, has shown that the use of PPIs and dual antiplatelet therapy improves outcomes of GI bleeding, without compromising cardiovascular outcomes and that further randomized trials are required in this area 94 …”

Section: Medical Therapymentioning

confidence: 99%

Rethinking gastroesophageal reflux disorder

Banting

Badgery

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et al. 2020

Annals of the New York Academy of Sciences

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Gastroesophageal reflux disease (GERD) is a common clinical condition for which our understanding has evolved over the past decades. It is now considered a cluster of phenotypes with numerous anatomical and physiological abnormalities contributing to its pathophysiology. As such, it is important to first understand the underlying mechanism of the disease process for each patient before embarking on therapeutic interventions. The aim of our paper is to highlight the mechanisms contributing to GERD and review investigations and interpretation of these results. Finally, the paper reviews the available treatment modalities for this condition, ranging from medical intervention, endoscopic options through to surgery and its various techniques.

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Meta-Analysis of Efficacy and Safety of Proton Pump Inhibitors with Dual Antiplatelet Therapy for Coronary Artery Disease

Cited by 16 publications

References 60 publications

Co-prescription of Dual-Antiplatelet Therapy and Proton Pump Inhibitors: Current Guidelines

Co-prescription of Dual-Antiplatelet Therapy and Proton Pump Inhibitors: Current Guidelines

Safety and efficacy of dual antiplatelet therapy after percutaneous coronary interventions in patients with end-stage liver disease

Rethinking gastroesophageal reflux disorder

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