PMID- 30773427
OWN - NLM
STAT- MEDLINE
DCOM- 20200727
LR  - 20201201
IS  - 1878-0938 (Electronic)
IS  - 1553-8389 (Print)
IS  - 1878-0938 (Linking)
VI  - 20
IP  - 12
DP  - 2019 Dec
TI  - Meta-Analysis of Efficacy and Safety of Proton Pump Inhibitors with Dual 
      Antiplatelet Therapy for Coronary Artery Disease.
PG  - 1125-1133
LID - S1553-8389(19)30107-1 [pii]
LID - 10.1016/j.carrev.2019.02.002 [doi]
AB  - BACKGROUND: There is inconsistency in the literature regarding the clinical 
      effects of proton pump inhibitors (PPI) when added to dual antiplatelet therapy 
      (DAPT) in subjects with coronary artery disease (CAD). We performed meta-analysis 
      stratified by study design to explore these differences. METHODS AND RESULTS: 39 
      studies [4 randomized controlled trials (RCTs) and 35 observational studies) were 
      selected using MEDLINE, EMBASE and CENTRAL (Inception-January 2018). In 221,204 
      patients (PPI = 77,731 patients, no PPI =143,473 patients), RCTs restricted 
      analysis showed that PPI did not increase the risk of all-cause mortality (Risk 
      Ratio (RR): 1.35, 95% Confidence Interval (CI), 0.56-3.23, P = 0.50, I(2) = 0), 
      cardiovascular mortality (RR: 0.94, 95% CI, 0.25-3.54, P = 0.92, I(2) = 56), 
      myocardial infarction (MI) (RR: 0.97, 95% CI, 0.62-1.51, P = 0.88, I(2) = 0) or 
      stroke (RR: 1.11, 95% CI, 0.25-5.04, P = 0.89, I(2) = 26). However, PPI 
      significantly reduced the risk of gastrointestinal (GI) bleeding (RR: 0.32, 95% 
      CI, 0.20-0.52, P < 0.001, I(2) = 0). Conversely, analysis of observational 
      studies showed that PPI significantly increased the risk of all-cause mortality 
      (RR: 1.25, 95% CI, 1.11-1.41, P < 0.001, I(2) = 82), cardiovascular mortality 
      (RR: 1.25, 95% CI, 1.03-1.52, P = 0.02, I(2) = 71), MI (RR: 1.30, 95% CI, 
      1.16-1.47, P < 0.001, I(2) = 82) and stroke (RR: 1.60, 95% CI, 1.43-1.78, 
      P < 0.001, I(2) = 0), without reducing GI bleeding (RR: 0.74, 95% CI, 0.45-1.22, 
      P = 0.24, I(2) = 79). CONCLUSION: Meta-analysis of RCTs endorsed the use of PPI 
      with DAPT for reducing GI bleeding without worsening cardiovascular outcomes. 
      These findings oppose the negative observational data regarding effects of PPI 
      with DAPT.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Khan, Safi U
AU  - Khan SU
AD  - West Virginia University, Morgantown, WV, USA. Electronic address: 
      safinmc@gmail.com.
FAU - Lone, Ahmad N
AU  - Lone AN
AD  - West Virginia University, Morgantown, WV, USA.
FAU - Asad, Zain Ul Abideen
AU  - Asad ZUA
AD  - University of Oklahoma, Oklahoma City, OK, USA.
FAU - Rahman, Hammad
AU  - Rahman H
AD  - Guthrie Health System/Robert Packer Hospital, Sayre, PA, USA.
FAU - Khan, Muhammad Shahzeb
AU  - Khan MS
AD  - John H. Stroger, Jr. Hospital of Cook County, Chicago, OH, USA.
FAU - Saleem, Muhammad A
AU  - Saleem MA
AD  - Mercy Health, Janesville, WI, USA.
FAU - Arshad, Adeel
AU  - Arshad A
AD  - Unity Hospital/Rochester Regional Health System, Rochester, NY, USA.
FAU - Nawaz, Najma
AU  - Nawaz N
AD  - Khyber Medical College, Peshawar, Pakistan.
FAU - Sattur, Sudhakar
AU  - Sattur S
AD  - Guthrie Health System/Robert Packer Hospital, Sayre, PA, USA.
FAU - Kaluski, Edo
AU  - Kaluski E
AD  - Guthrie Health System/Robert Packer Hospital, Sayre, PA, USA.
LA  - eng
GR  - U54 GM104942/GM/NIGMS NIH HHS/United States
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20190210
PL  - United States
TA  - Cardiovasc Revasc Med
JT  - Cardiovascular revascularization medicine : including molecular interventions
JID - 101238551
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Coronary Artery Disease/*drug therapy/mortality
MH  - Drug Therapy, Combination
MH  - Female
MH  - Gastrointestinal Hemorrhage/chemically induced/mortality/*prevention & control
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Observational Studies as Topic
MH  - Platelet Aggregation Inhibitors/*administration & dosage/adverse effects
MH  - Proton Pump Inhibitors/*administration & dosage/adverse effects
MH  - Randomized Controlled Trials as Topic
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC7489463
MID - NIHMS1620969
OTO - NOTNLM
OT  - Coronary artery disease
OT  - Dual antiplatelet therapy
OT  - Meta- analysis
OT  - Proton pump inhibitors
EDAT- 2019/02/19 06:00
MHDA- 2020/07/28 06:00
PMCR- 2020/12/01
CRDT- 2019/02/19 06:00
PHST- 2018/11/20 00:00 [received]
PHST- 2019/01/16 00:00 [revised]
PHST- 2019/02/05 00:00 [accepted]
PHST- 2019/02/19 06:00 [pubmed]
PHST- 2020/07/28 06:00 [medline]
PHST- 2019/02/19 06:00 [entrez]
PHST- 2020/12/01 00:00 [pmc-release]
AID - S1553-8389(19)30107-1 [pii]
AID - 10.1016/j.carrev.2019.02.002 [doi]
PST - ppublish
SO  - Cardiovasc Revasc Med. 2019 Dec;20(12):1125-1133. doi: 
      10.1016/j.carrev.2019.02.002. Epub 2019 Feb 10.