Schreiner Geoffrey C, Laine Loren, Murphy Sabina A, Cannon Christopher P
Thrombolysis in Myocardial Infarction Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Crit Pathw Cardiol. 2007 Dec;6(4):169-72. doi: 10.1097/HPC.0b013e318159921e.
Use of proton pump inhibitor (PPI) reduces the risk of gastrointestinal (GI) bleeding, and is generally recommended for high GI risk patients taking nonsteroidal anti-inflammatory agents. Aspirin and/or anticoagulants have been identified as increasing the risk of GI bleeding, whereby use of PPI could reduce this risk. The use of PPI in routine practice is not well defined, especially in patients with acute coronary syndromes (ACS) who require one or several antithrombotic drugs.
We analyzed the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction (PROVE IT-TIMI) 22 trial database, which enrolled patients who had been hospitalized for ACS. Patients were to be treated with aspirin, and received clopidogrel and/or warfarin at the discretion of the treating physician. We analyzed the use of PPI at baseline, which was not specified in the protocol, according to prior known GI risk factors.
Of the 4162 patients enrolled, 781 (18.8%) received PPI during the course of this study. The use ranged from 14% to 67% across the number of GI risk factors of 0 to > or =4 (P < 0.0001). Individual factors most associated with increased use of PPI were a prior GI event (RR = 2.3, P < 0.001) and use of anticoagulants (RR = 1.49, P < 0.001), but not dual antiplatelet therapy.
Use of PPI following ACS is modest, although it did increase with an increasing number of previously identified GI risk factors. Further, larger studies are warranted to validate prior, or identify new, risk factors as predictors of long-term bleeding, and improve awareness of GI bleeding risk such that use of PPI could be optimized.
质子泵抑制剂（PPI）的使用可降低胃肠道（GI）出血风险，通常推荐用于服用非甾体抗炎药且胃肠道风险高的患者。阿司匹林和/或抗凝剂已被确定会增加胃肠道出血风险，而使用PPI可降低此风险。PPI在常规临床实践中的使用情况尚不明确，尤其是在需要使用一种或多种抗血栓药物的急性冠状动脉综合征（ACS）患者中。
我们分析了普伐他汀或阿托伐他汀评估与感染治疗-心肌梗死溶栓（PROVE IT-TIMI）22试验数据库，该试验纳入了因ACS住院的患者。患者接受阿司匹林治疗，并根据治疗医生的判断接受氯吡格雷和/或华法林治疗。我们根据先前已知的胃肠道风险因素分析了基线时PPI的使用情况，该情况在研究方案中未作具体规定。
在纳入的4162例患者中，781例（18.8%）在本研究过程中接受了PPI治疗。胃肠道风险因素数量从0至≥4时，PPI的使用比例在14%至67%之间（P<0.0001）。与PPI使用增加最相关的个体因素是既往胃肠道事件（RR=2.3，P<0.001）和抗凝剂的使用（RR=1.49，P<0.001），而非双联抗血小板治疗。
ACS后PPI的使用并不普遍，尽管其使用确实随着先前确定的胃肠道风险因素数量的增加而增加。此外，需要开展更大规模的研究来验证先前的或确定新的风险因素作为长期出血的预测指标，并提高对胃肠道出血风险的认识，以便优化PPI的使用。
