Reduction in postpercutaneous coronary intervention angina in addition to gastrointestinal events in patients on combined proton pump inhibitors and dual antiplatelet therapy: a systematic review and meta-analysis

Abstract

Concomitantly administered PPIs with P2Y12 inhibitors have a protective effect on the GI events. It also decreases the post-PCI angina without increased adverse cardiovascular outcomes.

Clinical Outcomes of Concomitant Use of Proton Pump Inhibitors and Dual Antiplatelet Therapy: A Systematic Review and Meta-Analysis

“…Our findings from the pooled analysis of RCTs show that the use of PPIs was not associated with the risks of adverse CV outcomes and data from observational studies showed that omeprazole, esomeprazole, and rabeprazole were not associated with MACEs. These findings are consistent with a previous meta-analysis of RCTs, which found no association or increased risks of adverse CV outcomes with the use of PPIs ( Khan et al, 2018 ). A post-analysis of RCTs conducted by O’Donoghue et al (2009) reported that the mean inhibition of platelet aggregation was significantly lower for the PPI group as compared with the non-PPI group, despite the use of higher loading and maintenance doses of clopidogrel.…”

“…Although most previous studies mainly focused on the effects of PPIs on CV outcomes in patients receiving clopidogrel (Kwok and Loke, 2010;Siller-Matula et al, 2010;Chen et al, 2012;Gerson et al, 2012;Kwok et al, 2013;Melloni et al, 2015;Sherwood et al, 2015;Serbin et al, 2016;Bundhun et al, 2017;Niu et al, 2017;Demcsák et al, 2018;Khan et al, 2018), the current study is the first comprehensive systematic review to examine the efficacy and safety profile of PPIs combined with DAPT in patients after PCI or ACS and is, to the best of our knowledge, the only study to evaluate the safety of PPIs with the concomitant use of other P2Y 12 inhibitors. This review of 22 studies with 6,930 patients from RCTs to 183,546 patients from observational studies showed that the use of PPIs probably reduced the risk of GI bleeding and UGI bleeding relative to no PPI use.…”

Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group

“…No randomized trials were found assessing the use of PPIs in patients receiving DAPT who had a history of ulcer bleeding. Two systematic reviews were found in patients receiving DAPT after percutaneous coronary intervention or in the presence of coronary artery disease (93,94). The reporting and methodological quality of both reviews were suboptimal, with inclusion of studies that were not eligible (for example, because of patients not receiving DAPT, incorrect comparisons, or double counting).…”

Management of bleeding and procedures in patients on antiplatelet therapy

“…Early endoscopic control of bleeding can prevent surgical intervention, reduce inpatient stay, and is recommended for patients suspected to have upper GI haemorrhage (45). Proton pump inhibition (PPI) is recommended in all patients unless contraindicated, as it has been shown to improve outcomes in both the acute bleed (46) and prevention of re-bleeds in patients continuing both single-agent and dual-agent antiplatelet therapy (47,48). Choice of PPI should take the degree of inhibition of CYP2C19 into consideration, particularly for patients taking clopidogrel, which requires metabolism by this enzyme amongst others into its active form.…”