Baik Minyoul, Jeon Jimin, Heo Seok-Jae, Kim Jinkwon, Yoo Joonsang
Department of Neurology, Yongin Severance Hospital Yonsei University College of Medicine Yongin-si Gyeonggi-do South Korea.
Division of Biostatistics, Department of Biomedical Systems Informatics Yonsei University College of Medicine Seoul Republic of Korea.
J Am Heart Assoc. 2025 Jan 7;14(1):e035239. doi: 10.1161/JAHA.124.035239. Epub 2024 Dec 24.
Current guidelines lack recommendations regarding the use of proton pump inhibitors (PPIs) for preventing upper gastrointestinal bleeding (UGIB) among patients at low risk for UGIB treated with dual antiplatelet therapy for ischemic stroke (IS). Our objective was to assess the effectiveness of PPIs in lowering the risk of significant UGIB in this patient group.
A retrospective cohort study was conducted involving patients at low risk for UGIB admitted for IS between 2014 and 2018 and treated with dual antiplatelet therapy. The study used a nationwide claims database in Korea. The primary end point was significant UGIB during 12 months after IS. To evaluate the risk of significant UGIB based on PPI use, we performed a multivariable Cox regression analysis. Subgroup analyses and propensity score matching analysis were conducted for validation. Among 96 722 patients with IS at low risk for UGIB who were on dual antiplatelet therapy (mean age, 67.0 years; men: 63.0%), 16 084 (16.6%) were treated with PPIs. During 12 months of follow-up, 325 patients experienced significant UGIB, and 479 experienced any UGIB. PPI use was associated with a reduced risk of significant UGIB (hazard ratio, 0.63 [95% CI, 0.45-0.89]; =0.009). This association was consistent in the subgroup and propensity score matching analyses.
In patients with IS receiving dual antiplatelet therapy, PPI use reduced the risk of significant UGIB by 37% on average, even among low-risk patients. However, the use of PPIs in this patient group was limited, highlighting the need for additional prospective studies.
目前的指南缺乏关于在接受双重抗血小板治疗的缺血性卒中（IS）低上消化道出血（UGIB）风险患者中使用质子泵抑制剂（PPI）预防UGIB的建议。我们的目的是评估PPI在降低该患者群体发生严重UGIB风险方面的有效性。
进行了一项回顾性队列研究，纳入2014年至2018年间因IS入院且接受双重抗血小板治疗的UGIB低风险患者。该研究使用了韩国的全国性索赔数据库。主要终点是IS后12个月内发生的严重UGIB。为了评估基于PPI使用情况的严重UGIB风险，我们进行了多变量Cox回归分析。进行亚组分析和倾向评分匹配分析以进行验证。在96722例接受双重抗血小板治疗的UGIB低风险IS患者中（平均年龄67.0岁；男性占63.0%），16084例（16.6%）接受了PPI治疗。在12个月的随访期间，325例患者发生了严重UGIB，479例发生了任何UGIB。使用PPI与严重UGIB风险降低相关（风险比，0.63 [95% CI，0.45 - 0.89]；P = 0.009）。这种关联在亚组分析和倾向评分匹配分析中是一致的。
在接受双重抗血小板治疗的IS患者中，即使在低风险患者中，使用PPI也平均降低了37%的严重UGIB风险。然而，该患者群体中PPI的使用有限，这突出了进行更多前瞻性研究的必要性。
