PMID- 29339434
OWN - NLM
STAT- MEDLINE
DCOM- 20180320
LR  - 20220321
IS  - 1524-4628 (Electronic)
IS  - 0039-2499 (Linking)
VI  - 49
IP  - 2
DP  - 2018 Feb
TI  - Cerebrovascular Outcomes With Proton Pump Inhibitors and Thienopyridines: A 
      Systematic Review and Meta-Analysis.
PG  - 312-318
LID - 10.1161/STROKEAHA.117.019166 [doi]
AB  - BACKGROUND AND PURPOSE: Pharmacokinetic and prior studies on thienopyridine and 
      proton pump inhibitors (PPI) coadministration provide conflicting data for 
      cardiovascular outcomes, whereas there is no established evidence on the 
      association of concomitant use of PPI and thienopyridines with adverse 
      cerebrovascular outcomes. METHODS: We conducted a systematic review and 
      meta-analysis of randomized controlled trials and cohort studies from inception 
      to July 2017, reporting following outcomes among patients treated with 
      thienopyridine and PPI versus thienopyridine alone (1) ischemic stroke, (2) 
      combined ischemic or hemorrhagic stroke, (3) composite outcome of stroke, 
      myocardial infarction (MI), and cardiovascular death, (4) MI, (5) all-cause 
      mortality, and (6) major or minor bleeding events. After the unadjusted analyses 
      of risk ratios, we performed additional analyses of studies reporting hazard 
      ratios adjusted for potential confounders. RESULTS: We identified 22 studies (12 
      randomized controlled trials and 10 cohort studies) comprising 131 714 patients. 
      Concomitant use of PPI with thienopyridines was associated with increased risk of 
      ischemic stroke (risk ratio, 1.74; 95% confidence interval [CI], 1.41-2.16; 
      P<0.001), composite stroke/MI/cardiovascular death (risk ratio, 1.14; 95% CI, 
      1.01-1.29; P=0.04), and MI (risk ratio, 1.19; 95% CI, 1.00-1.40; P=0.05). 
      Likewise, in adjusted analyses concomitant use of PPI with thienopyridines was 
      again associated with increased risk of stroke (hazard ratios adjusted, 1.30; 95% 
      CI, 1.04-1.61; P=0.02), composite stroke/MI/cardiovascular death (hazard ratios 
      adjusted, 1.23; 95% CI, 1.03-1.47; P=0.02), but not with MI (hazard ratios 
      adjusted, 1.19; 95% CI, 0.93-1.52; P=0.16). CONCLUSIONS: Co-prescription of PPI 
      and thienopyridines increases the risk of incident ischemic strokes and composite 
      stroke/MI/cardiovascular death. Our findings corroborate the current guidelines 
      for PPI deprescription and pharmacovigilance, especially in patients treated with 
      thienopyridines.
CI  - (c) 2018 American Heart Association, Inc.
FAU - Malhotra, Konark
AU  - Malhotra K
AD  - From the Department of Neurology, West Virginia University-Charleston Division 
      (K.M.); Second Department of Neurology, National and Kapodistrian University of 
      Athens, "Attikon" University Hospital, Greece (A.H.K., G.T.); Department of 
      Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department 
      of Gastroenterology & Hepatology, University of Texas Medical Branch, Galveston 
      (M.B.); and Department of Neurology, University of Tennessee Health Science 
      Center, Memphis (M.F.I., N.G., G.T.). konark.malhotra@yahoo.com.
FAU - Katsanos, Aristeidis H
AU  - Katsanos AH
AD  - From the Department of Neurology, West Virginia University-Charleston Division 
      (K.M.); Second Department of Neurology, National and Kapodistrian University of 
      Athens, "Attikon" University Hospital, Greece (A.H.K., G.T.); Department of 
      Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department 
      of Gastroenterology & Hepatology, University of Texas Medical Branch, Galveston 
      (M.B.); and Department of Neurology, University of Tennessee Health Science 
      Center, Memphis (M.F.I., N.G., G.T.).
FAU - Bilal, Mohammad
AU  - Bilal M
AD  - From the Department of Neurology, West Virginia University-Charleston Division 
      (K.M.); Second Department of Neurology, National and Kapodistrian University of 
      Athens, "Attikon" University Hospital, Greece (A.H.K., G.T.); Department of 
      Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department 
      of Gastroenterology & Hepatology, University of Texas Medical Branch, Galveston 
      (M.B.); and Department of Neurology, University of Tennessee Health Science 
      Center, Memphis (M.F.I., N.G., G.T.).
FAU - Ishfaq, Muhammad Fawad
AU  - Ishfaq MF
AD  - From the Department of Neurology, West Virginia University-Charleston Division 
      (K.M.); Second Department of Neurology, National and Kapodistrian University of 
      Athens, "Attikon" University Hospital, Greece (A.H.K., G.T.); Department of 
      Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department 
      of Gastroenterology & Hepatology, University of Texas Medical Branch, Galveston 
      (M.B.); and Department of Neurology, University of Tennessee Health Science 
      Center, Memphis (M.F.I., N.G., G.T.).
FAU - Goyal, Nitin
AU  - Goyal N
AD  - From the Department of Neurology, West Virginia University-Charleston Division 
      (K.M.); Second Department of Neurology, National and Kapodistrian University of 
      Athens, "Attikon" University Hospital, Greece (A.H.K., G.T.); Department of 
      Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department 
      of Gastroenterology & Hepatology, University of Texas Medical Branch, Galveston 
      (M.B.); and Department of Neurology, University of Tennessee Health Science 
      Center, Memphis (M.F.I., N.G., G.T.).
FAU - Tsivgoulis, Georgios
AU  - Tsivgoulis G
AD  - From the Department of Neurology, West Virginia University-Charleston Division 
      (K.M.); Second Department of Neurology, National and Kapodistrian University of 
      Athens, "Attikon" University Hospital, Greece (A.H.K., G.T.); Department of 
      Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department 
      of Gastroenterology & Hepatology, University of Texas Medical Branch, Galveston 
      (M.B.); and Department of Neurology, University of Tennessee Health Science 
      Center, Memphis (M.F.I., N.G., G.T.).
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20180116
PL  - United States
TA  - Stroke
JT  - Stroke
JID - 0235266
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
RN  - 0 (Thienopyridines)
SB  - IM
CIN - Stroke. 2018 Apr;49(4):e169. PMID: 29581348
CIN - Stroke. 2018 Apr;49(4):e170. PMID: 29581349
CIN - Stroke. 2018 Apr;49(4):e171-e172. PMID: 29581350
MH  - Brain Ischemia/*drug therapy
MH  - Drug Therapy, Combination/methods
MH  - Humans
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Stroke/*drug therapy
MH  - Thienopyridines/*therapeutic use
OTO - NOTNLM
OT  - ischemic stroke
OT  - myocardial infarction
OT  - pharmacovigilance
OT  - proton pump inhibitors
OT  - thienopyridines
EDAT- 2018/01/18 06:00
MHDA- 2018/03/21 06:00
CRDT- 2018/01/18 06:00
PHST- 2017/08/21 00:00 [received]
PHST- 2017/10/27 00:00 [revised]
PHST- 2017/11/21 00:00 [accepted]
PHST- 2018/01/18 06:00 [pubmed]
PHST- 2018/03/21 06:00 [medline]
PHST- 2018/01/18 06:00 [entrez]
AID - STROKEAHA.117.019166 [pii]
AID - 10.1161/STROKEAHA.117.019166 [doi]
PST - ppublish
SO  - Stroke. 2018 Feb;49(2):312-318. doi: 10.1161/STROKEAHA.117.019166. Epub 2018 Jan 
      16.