Cao Lu, Quan Kejia, Zhang Dan, Li Rui, Zhou Nan, Zhang Peng
Department of Pharmacy, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
Department of Pharmacy, The First Hospital of Weinan City, Weinan, Shaanxi, China.
Front Pharmacol. 2025 Jul 30;16:1644148. doi: 10.3389/fphar.2025.1644148. eCollection 2025.
To analyse the use of prophylactic proton pump inhibitors (PPIs) and their benefits for the prevention of gastrointestinal injury and to determine the optimal course of preventive use among patients with minor ischaemic stroke (IS) and transient ischaemic attack (TIA) at low risk of gastrointestinal bleeding (GIB) treated with short-term dual-antiplatelet therapy (DAPT).
We retrospectively collected clinical data from the hospital information system (HIS) from January 2022 to December 2023. The data were collected from patients who were admitted to a tertiary hospital with a first occurrence of minor IS/TIA diagnosed within 14 days and treated with short-term DAPT. Univariate and multivariate logistic regression analyses were used to explore the correlations between the use of PPIs, different treatment durations, and the incidence rates of GIB, gastrointestinal discomfort, other types of bleeding, and pneumonia in these patients.
A total of 220 patients were included, with 52 in the PPI group (23.64%) and 168 in the non-PPI group (76.36%). The results showed that PPI use did not significantly reduce the incidence of GIB (P = 0.059) or other types of bleeding (P = 0.916) in patients who were treated with DAPT and were at low risk of GIB. The incidence of pneumonia in the PPI group was higher than that in the non-PPI group, but the difference was not statistically significant (42.86% vs. 23.00%, P = 0.840). However, PPI use significantly reduced the occurrence of gastrointestinal discomfort (P = 0.033, OR: 0.448; 95% CI: 0.215-0.935), with no significant difference based on treatment duration (≤7 days vs. >7 days, P = 0.520).
Regular use of PPIs within the first 7 days of initiating DAPT in patients with minor IS/TIA at low risk of GIB significantly reduces symptoms of gastrointestinal discomfort while minimizing adverse effects due to overuse of PPIs.
分析预防性使用质子泵抑制剂（PPI）的情况及其对预防胃肠道损伤的益处，并确定在接受短期双联抗血小板治疗（DAPT）且胃肠道出血（GIB）风险较低的轻度缺血性卒中（IS）和短暂性脑缺血发作（TIA）患者中预防性使用PPI的最佳疗程。
我们回顾性收集了2022年1月至2023年12月医院信息系统（HIS）中的临床数据。数据收集自一家三级医院收治的首次发生轻度IS/TIA且在14天内确诊并接受短期DAPT治疗的患者。采用单因素和多因素逻辑回归分析来探讨PPI的使用、不同治疗持续时间与这些患者中GIB、胃肠道不适、其他类型出血及肺炎发生率之间的相关性。
共纳入220例患者，PPI组52例（23.64%），非PPI组168例（76.36%）。结果显示，在接受DAPT且GIB风险较低的患者中，使用PPI并未显著降低GIB（P = 0.059）或其他类型出血（P = 0.916）的发生率。PPI组肺炎发生率高于非PPI组，但差异无统计学意义（42.86%对23.00%，P = 0.840）。然而，使用PPI显著降低了胃肠道不适的发生（P = 0.033，OR：0.448；95%CI：0.215 - 0.935），基于治疗持续时间（≤7天对>7天）无显著差异（P = 0.520）。
在GIB风险较低的轻度IS/TIA患者中，在开始DAPT的前7天内定期使用PPI可显著减轻胃肠道不适症状，同时将因过度使用PPI导致的不良反应降至最低。
