He Yong, Xiang Guangpeng, Zhu Tieshi
Department of Neurology, Liuyang Jili Hospital, Changsha, Hunan, China.
Department of Hematology, Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, Guangdong, China.
J Clin Neurosci. 2025 Mar;133:111056. doi: 10.1016/j.jocn.2025.111056. Epub 2025 Jan 23.
Stroke is a leading cause of death and disability worldwide. Antiplatelet therapy is essential for preventing ischemic stroke recurrence, but it carries a risk of gastrointestinal (GI) bleeding. Proton pump inhibitors (PPIs) are often prescribed to mitigate this risk, but their long-term use has been linked to increased all-cause mortality. Limited research exists on the impact of PPI use on mortality in stroke survivors receiving antiplatelet therapy. This study aims to evaluate the association between PPI use and all-cause mortality in this population.
Data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 were used. A total of 335 stroke survivors on antiplatelet therapy were included and classified based on PPI use. All-cause mortality was determined by linkage to the National Death Index. Weighted Cox regression models were used to assess the association between PPI use and all-cause mortality, adjusting for key covariates such as age, sex, race, socioeconomic status, and comorbidities.
Among 335 participants, 78 used PPIs. No significant association was found between PPI use and all-cause mortality across all models (HR 0.98, 95 % CI 0.67-1.42, p = 0.95). Subgroup analysis indicated that PPIs use was not associated with all-cause mortality risk in any of the subgroups. Kaplan-Meier curves showed no significant difference in survival between PPI and non-PPI groups (p = 0.79).
PPI use in stroke survivors on antiplatelet therapy was not associated with increased all-cause mortality. The decision to use PPIs should involve a careful evaluation of the potential benefits and risks.
中风是全球死亡和残疾的主要原因。抗血小板治疗对于预防缺血性中风复发至关重要，但它有胃肠道（GI）出血的风险。质子泵抑制剂（PPI）常被处方用于降低这种风险，但其长期使用与全因死亡率增加有关。关于PPI使用对接受抗血小板治疗的中风幸存者死亡率的影响，现有研究有限。本研究旨在评估该人群中PPI使用与全因死亡率之间的关联。
使用了1999年至2018年美国国家健康和营养检查调查（NHANES）的数据。共有335名接受抗血小板治疗的中风幸存者被纳入，并根据PPI使用情况进行分类。通过与国家死亡指数的关联确定全因死亡率。使用加权Cox回归模型评估PPI使用与全因死亡率之间的关联，并对年龄、性别、种族、社会经济地位和合并症等关键协变量进行调整。
在335名参与者中，78人使用了PPI。在所有模型中，未发现PPI使用与全因死亡率之间存在显著关联（风险比[HR] 0.98，95%置信区间[CI] 0.67 - 1.42，p = 0.95）。亚组分析表明，在任何亚组中，PPI使用与全因死亡风险均无关联。Kaplan-Meier曲线显示，PPI组和非PPI组之间的生存率无显著差异（p = 0.79）。
在接受抗血小板治疗的中风幸存者中，使用PPI与全因死亡率增加无关。使用PPI的决定应仔细评估潜在的益处和风险。
