PMID- 35164933 OWN - NLM STAT- MEDLINE DCOM- 20220406 LR - 20220531 IS - 1942-5546 (Electronic) IS - 0025-6196 (Linking) VI - 97 IP - 4 DP - 2022 Apr TI - Proton Pump Inhibitors and In-Hospital Gastrointestinal Bleeding in Patients With Acute Coronary Syndrome Receiving Dual Antiplatelet Therapy. PG - 682-692 LID - S0025-6196(21)00919-8 [pii] LID - 10.1016/j.mayocp.2021.11.037 [doi] AB - OBJECTIVE: To evaluate the association between proton pump inhibitor (PPI) use and in-hospital gastrointestinal (GI) bleeding in patients with acute coronary syndrome (ACS) taking dual antiplatelet therapy (DAPT). PATIENTS AND METHODS: This study is based on the Improving Care for Cardiovascular Disease in China-ACS project, an ongoing collaborative registry and quality improvement project of the American Heart Association and the Chinese Society of Cardiology. A total of 25,567 patients with ACS taking DAPT from 172 hospitals from July 1, 2017, through December 31, 2018, were included. Multivariable Cox regression and propensity score-matched analyses were used to evaluate the association between PPI use and in-hospital GI bleeding. RESULTS: Of these patients with ACS, 63.9% (n=16,332) were prescribed PPIs within 24 hours of admission. Patients using PPIs had a higher rate of GI bleeding compared with those not using PPIs (1.0% vs 0.5%; P<.001). In the multivariable Cox regression analysis, early PPI use was associated with a 58% higher risk of GI bleeding (hazard ratio, 1.58; 95% CI, 1.15 to 2.18; P=.005). Further propensity score matching attenuated the association but still showed that patients using PPIs had a higher rate of GI bleeding (0.8% vs 0.6%; P=.04). CONCLUSION: In China, PPIs are widely used within 24 hours of admission in patients with ACS taking DAPT. An increased risk of GI bleeding is observed in inpatients with early PPI use. Randomized trials on early use of PPIs in patients with ACS receiving DAPT are warranted. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02306616. CI - Copyright (c) 2022. Published by Elsevier Inc. FAU - Zhou, Mengge AU - Zhou M AD - Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China; Vanke School of Public Health, Tsinghua University. FAU - Zhang, Jie AU - Zhang J AD - Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. FAU - Liu, Jing AU - Liu J AD - Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China. FAU - Smith, Sidney C Jr AU - Smith SC Jr AD - Division of Cardiology, University of North Carolina, Chapel Hill. FAU - Ma, Changsheng AU - Ma C AD - Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. FAU - Ge, Junbo AU - Ge J AD - Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China. FAU - Huo, Yong AU - Huo Y AD - Department of Cardiology, Peking University First Hospital, Beijing, China. FAU - Fonarow, Gregg C AU - Fonarow GC AD - Division of Cardiology, Geffen School of Medicine at University of California, Los Angeles. FAU - Liu, Jun AU - Liu J AD - Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China. FAU - Hao, Yongchen AU - Hao Y AD - Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China. FAU - Gao, Feng AU - Gao F AD - Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. FAU - Sun, Yamei AU - Sun Y AD - Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. FAU - Morgan, Louise AU - Morgan L AD - International Quality Improvement Department, American Heart Association, Dallas, TX. FAU - Yang, Na AU - Yang N AD - Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China. FAU - Hu, Guoliang AU - Hu G AD - Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China. FAU - Zeng, Yuhong AU - Zeng Y AD - Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China. FAU - Han, Yaling AU - Han Y AD - Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China. Electronic address: hanyaling@263.net. FAU - Zhao, Dong AU - Zhao D AD - Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China. Electronic address: deezhao@vip.sina.com. CN - CCC-ACS Investigators LA - eng SI - ClinicalTrials.gov/NCT02306616 PT - Clinical Study PT - Journal Article DEP - 20220212 PL - England TA - Mayo Clin Proc JT - Mayo Clinic proceedings JID - 0405543 RN - 0 (Platelet Aggregation Inhibitors) RN - 0 (Proton Pump Inhibitors) SB - IM CIN - Mayo Clin Proc. 2022 Apr;97(4):648-651. PMID: 35379417 MH - *Acute Coronary Syndrome/complications/drug therapy MH - Drug Therapy, Combination MH - Gastrointestinal Hemorrhage/chemically induced/complications MH - Hospitals MH - Humans MH - Platelet Aggregation Inhibitors/adverse effects MH - *Proton Pump Inhibitors/adverse effects MH - Treatment Outcome EDAT- 2022/02/16 06:00 MHDA- 2022/04/07 06:00 CRDT- 2022/02/15 05:32 PHST- 2020/12/08 00:00 [received] PHST- 2021/09/12 00:00 [revised] PHST- 2021/11/19 00:00 [accepted] PHST- 2022/02/16 06:00 [pubmed] PHST- 2022/04/07 06:00 [medline] PHST- 2022/02/15 05:32 [entrez] AID - S0025-6196(21)00919-8 [pii] AID - 10.1016/j.mayocp.2021.11.037 [doi] PST - ppublish SO - Mayo Clin Proc. 2022 Apr;97(4):682-692. doi: 10.1016/j.mayocp.2021.11.037. Epub 2022 Feb 12.