Hu Wen, Tong Jin, Kuang Xue, Chen Weijie, Liu Zengzhang
Department of Cardiology Department of Respirology, The Second Affiliated Hospital/The Second Clinical Institute, Chongqing Medical University, Chongqing, China.
Medicine (Baltimore). 2018 Jan;97(3):e9638. doi: 10.1097/MD.0000000000009638.
Proton pump inhibitors (PPIs) are usually prescribed to protect against gastrointestinal bleeding in patients on dual antiplatelet therapy. This meta-analysis reviewed clinical outcomes in patients taking aspirin and clopidogrel, with and without concomitant PPIs to address concerns of adverse reactions.
We searched PubMed, Embase, and the Cochrane Library for articles published between January 1, 2010 and April 11, 2017. The primary end points were major adverse cardiovascular events and gastrointestinal bleeding. Secondary end points were myocardial infarction, stent thrombosis, revascularization, cardiogenic death, and all-cause mortality.
The meta-analysis included 33,492 patients in 4 randomized controlled trials and 8 controlled observational studies. Overall, patients taking PPIs had statistical differences in major adverse cardiovascular events [odds ratio (OR) 1.17 (95% confidence interval [CI] 1.07-1.28); P = .001; I = 28.3%], gastrointestinal bleeding [OR 0.58 (95% CI 0.36-0.92); P = .022; I = 80.6%], stent thrombosis [OR 1.30 (95% CI 1.01-1.68); P = .041; I = 0%], and revascularization [OR 1.20 (95% CI 1.04-1.38); P = .011; I = 5.1%], compared those not taking PPIs. There were no significant differences in myocardial infarction [OR 1.03 (95% CI 0.87-1.22); P = .742; I = 0%], cardiogenic death [OR 1.09 (95% CI 0.83-1.43); P = .526; I = 0%], or all-cause mortality [OR 1.08 (95% CI 0.93-1.25); P = .329; I = 0%).
Among the patients taking aspirin and clopidogrel, the results indicated that the combined use of PPIs increased the rates of major adverse cardiovascular events, stent thrombosis, and revascularization.
质子泵抑制剂（PPIs）通常用于预防接受双联抗血小板治疗的患者发生胃肠道出血。本荟萃分析回顾了服用阿司匹林和氯吡格雷的患者，无论是否同时使用PPIs的临床结局，以解决不良反应的问题。
我们检索了PubMed、Embase和Cochrane图书馆中2010年1月1日至2017年4月11日发表的文章。主要终点是主要不良心血管事件和胃肠道出血。次要终点是心肌梗死、支架血栓形成、血运重建、心源性死亡和全因死亡率。
该荟萃分析纳入了4项随机对照试验和8项对照观察性研究中的33492例患者。总体而言，服用PPIs的患者在主要不良心血管事件[比值比（OR）1.17（95%置信区间[CI]1.07-1.28）；P = 0.001；I = 28.3%]、胃肠道出血[OR 0.58（95%CI 0.36-0.92）；P = 0.022；I = 80.6%]、支架血栓形成[OR 1.30（95%CI 1.01-1.68）；P = 0.041；I = 0%]和血运重建[OR 1.20（95%CI 1.04-1.38）；P = 0.011；I = 5.1%]方面与未服用PPIs的患者存在统计学差异。在心肌梗死[OR 1.03（95%CI 0.87-1.22）；P = 0.742；I = 0%]、心源性死亡[OR 1.09（95%CI 0.83-1.43）；P = 0.526；I = 0%]或全因死亡率[OR 1.08（95%CI 0.93-1.25）；P = 0.329；I = 0%]方面无显著差异。
在服用阿司匹林和氯吡格雷的患者中，结果表明联合使用PPIs会增加主要不良心血管事件、支架血栓形成和血运重建的发生率。
