一项网状Meta分析：评估PCI术后患者同时使用质子泵抑制剂和氯吡格雷治疗的有效性和安全性。
A network meta-analysis: evaluating the efficacy and safety of concurrent proton pump inhibitors and clopidogrel therapy in post-PCI patients.
作者信息
Ai Ming-Ying, Chen Yan-Zuo, Kuo Chien-Liang, Chang Wei-Lun
机构信息
Department of Pharmacy, Far Eastern Memorial Hospital, New Taipei, Taiwan.
出版信息
Front Cardiovasc Med. 2024 Jul 24;11:1385318. doi: 10.3389/fcvm.2024.1385318. eCollection 2024.
INTRODUCTION
The objective of this research was to evaluate the risk of major adverse cardiovascular events (MACEs) associated with the use of various proton pump inhibitors (PPIs) in combination with clopidogrel in patients who underwent percutaneous coronary intervention (PCI).
METHODS
To accomplish this, we analyzed data from randomized controlled trials and retrospective cohort studies sourced from key electronic databases. These studies specifically examined the effects of different PPIs, such as lansoprazole, esomeprazole, omeprazole, rabeprazole, and pantoprazole, when used in conjunction with clopidogrel on MACEs. The primary focus was on the differential impact of these PPIs, while the secondary focus was on the comparison of gastrointestinal (GI) bleeding events in groups receiving different PPIs with clopidogrel vs. a placebo group. This study's protocol was officially registered with INPLASY (INPLASY2024-2-0009).
RESULTS
We conducted a network meta-analysis involving 16 studies with a total of 145,999 patients. Our findings indicated that rabeprazole when combined with clopidogrel, had the lowest increase in MACE risk (effect size, 1.05, 95% CI: 0.66-1.66), while lansoprazole was associated with the highest risk increase (effect size, 1.48, 95% CI: 1.22-1.80). Esomeprazole (effect size, 1.28, 95% CI: 1.09-1.51), omeprazole (effect size, 1.23, 95% CI: 1.07-1.43), and pantoprazole (effect size, 1.38, 95% CI: 1.18-1.60) also significantly increased MACE risk. For the secondary outcome, esomeprazole (effect size, 0.30, 95% CI: 0.09-0.94), omeprazole (effect size, 0.34, 95% CI: 0.14-0.81), and pantoprazole (effect size, 0.33, 95% CI: 0.13-0.84) demonstrated an increased potential for GI bleeding prevention.
CONCLUSIONS
In conclusion, the combination of lansoprazole and clopidogrel was found to significantly elevate the risk of MACEs without offering GI protection in post-PCI patients. This study is the first network meta-analysis to identify the most effective regimen for the concurrent use of clopidogrel with individual PPIs.
SYSTEMATIC REVIEW REGISTRATION
https://inplasy.com/inplasy-2024-2-0009/, identifier (INPLASY2024-2-0009).
引言
本研究的目的是评估在接受经皮冠状动脉介入治疗（PCI）的患者中，各种质子泵抑制剂（PPI）与氯吡格雷联合使用时发生主要不良心血管事件（MACE）的风险。
方法
为此，我们分析了来自主要电子数据库的随机对照试验和回顾性队列研究的数据。这些研究专门考察了不同的PPI，如兰索拉唑、埃索美拉唑、奥美拉唑、雷贝拉唑和泮托拉唑，与氯吡格雷联合使用对MACE的影响。主要重点是这些PPI的差异影响，次要重点是比较接受不同PPI与氯吡格雷联合治疗的组与安慰剂组的胃肠道（GI）出血事件。本研究方案已在INPLASY（INPLASY2024 - 2 - 0009）正式注册。
结果
我们进行了一项网络荟萃分析，涉及16项研究，共145,999名患者。我们的研究结果表明，雷贝拉唑与氯吡格雷联合使用时，MACE风险增加最低（效应量为1.05，95%可信区间：0.66 - 1.66），而兰索拉唑与最高的风险增加相关（效应量为1.48，95%可信区间：1.22 - 1.80）。埃索美拉唑（效应量为1.28，95%可信区间：1.09 - 1.51）、奥美拉唑（效应量为1.23，95%可信区间：1.07 - 1.43）和泮托拉唑（效应量为1.38，95%可信区间：1.18 - 1.60）也显著增加了MACE风险。对于次要结局，埃索美拉唑（效应量为0.30，95%可信区间：0.09 - 0.94）、奥美拉唑（效应量为0.34，95%可信区间：0.14 - 0.81）和泮托拉唑（效应量为0.33，95%可信区间：0.13 - 0.84）显示出预防GI出血的潜力增加。
结论
总之，在PCI术后患者中，发现兰索拉唑与氯吡格雷联合使用会显著增加MACE风险，且未提供胃肠道保护。本研究是第一项确定氯吡格雷与各PPI联合使用最有效方案的网络荟萃分析。
系统评价注册
https://inplasy.com/inplasy - 2024 - 2 - 0009/，标识符（INPLASY2024 - 2 - 0009）。
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