PMID- 28678044
OWN - NLM
STAT- MEDLINE
DCOM- 20180514
LR  - 20180514
IS  - 1473-5687 (Electronic)
IS  - 0954-691X (Linking)
VI  - 29
IP  - 10
DP  - 2017 Oct
TI  - Randomized clinical trial: the impact of gastrointestinal risk factor screening 
      and prophylactic proton pump inhibitor therapy in patients receiving dual 
      antiplatelet therapy.
PG  - 1118-1125
LID - 10.1097/MEG.0000000000000934 [doi]
AB  - OBJECTIVE: Dual antiplatelet therapy reduces the risk of ischemic complications 
      after acute coronary syndrome, but increases the risk of bleeding including upper 
      gastrointestinal bleeding (UGIB).The aim of this study was to examine the effect 
      of screening for risk of UGIB and prophylactic proton pump inhibitor (PPI) 
      treatment in dual-antiplatelet-treated patients at risk of UGIB and to assess the 
      significance of dual antiplatelet therapy compliance for cardiovascular events. 
      PATIENTS AND METHODS: In a register-based randomized-controlled trial, 2009 
      patients were included at the time of first percutaneous coronary intervention 
      and randomized to either screening or control. Screened high-risk patients were 
      prescribed pantoprazole 40 mg during the 1-year after percutaneous coronary 
      intervention. RESULTS: The incidence of UGIB was 0.8 versus 1.3% in screened 
      patients and controls, respectively (P=0.381).Significantly fewer screened 
      patients (5.4%) than controls (8.0%) underwent upper gastrointestinal endoscopy 
      (P=0.026). Screened patients (2.9%) had significantly fewer events of unstable 
      angina pectoris than controls (4.7%) (P=0.036) and a higher compliance to dual 
      antiplatelet therapy (88.3 vs. 85.0%) (P=0.035), but no statistically difference 
      was observed in the incidences of myocardial infarction and all-cause mortality 
      (1.0 vs. 1.5%) (P=0.422). CONCLUSION: Screening for risk factors for UGIB and 
      subsequent prophylactic PPI treatment did not significantly reduce the incidence 
      of UGIB. Prescription of PPI was associated with a higher compliance with dual 
      antiplatelet therapy and decreases the risk of recurrent cardiovascular events.
FAU - Jensen, Berit E S
AU  - Jensen BES
AD  - Departments of aMedical Gastroenterology bCardiology, Odense University Hospital 
      cDepartment of Public Health, University of Southern Denmark, Odense dDepartment 
      of Cardiology, Aarhus University Hospital, Skejby eDepartment of Cardiology, 
      Aalborg University Hospital, Aalborg, Denmark.
FAU - Hansen, Jane M
AU  - Hansen JM
FAU - Larsen, Kasper S
AU  - Larsen KS
FAU - Junker, Anders B
AU  - Junker AB
FAU - Lassen, Jens F
AU  - Lassen JF
FAU - Jensen, Svend E
AU  - Jensen SE
FAU - Schaffalitzky de Muckadell, Ove B
AU  - Schaffalitzky de Muckadell OB
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PL  - England
TA  - Eur J Gastroenterol Hepatol
JT  - European journal of gastroenterology & hepatology
JID - 9000874
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Denmark/epidemiology
MH  - Drug Therapy, Combination
MH  - Endoscopy, Gastrointestinal
MH  - Female
MH  - Gastrointestinal Hemorrhage/chemically induced/diagnosis/mortality/*prevention & 
      control
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Medication Adherence
MH  - Middle Aged
MH  - *Percutaneous Coronary Intervention/adverse effects/mortality
MH  - Platelet Aggregation Inhibitors/adverse effects/*therapeutic use
MH  - Prospective Studies
MH  - Protective Factors
MH  - Proton Pump Inhibitors/*administration & dosage/adverse effects
MH  - Registries
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2017/07/06 06:00
MHDA- 2018/05/15 06:00
CRDT- 2017/07/06 06:00
PHST- 2017/07/06 06:00 [pubmed]
PHST- 2018/05/15 06:00 [medline]
PHST- 2017/07/06 06:00 [entrez]
AID - 10.1097/MEG.0000000000000934 [doi]
PST - ppublish
SO  - Eur J Gastroenterol Hepatol. 2017 Oct;29(10):1118-1125. doi: 
      10.1097/MEG.0000000000000934.