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Review
. 2015 May 7;21(17):5382-92.
doi: 10.3748/wjg.v21.i17.5382.

Proton pump inhibitors in prevention of low-dose aspirin-associated upper gastrointestinal injuries

Chen Mo  1 , Gang Sun  1 , Ming-Liang Lu  1 , Li Zhang  1 , Yan-Zhi Wang  1 , Xi Sun  1 , Yun-Sheng Yang  1
Affiliations
Review

Proton pump inhibitors in prevention of low-dose aspirin-associated upper gastrointestinal injuries

Chen Mo et al. World J Gastroenterol. .

Abstract

Aim: To determine the preventive effect and safety of proton pump inhibitors (PPIs) in low-dose aspirin (LDA)-associated gastrointestinal (GI) ulcers and bleeding.

Methods: We searched MEDLINE, EMBASE and the Cochrane Controlled Trials Register from inception to December 2013, and checked conference abstracts of randomized controlled trials (RCTs) on the effect of PPIs in reducing adverse GI events (hemorrhage, ulcer, perforation, or obstruction) in patients taking LDA. The preventive effects of PPIs were compared with the control group [taking placebo, a cytoprotective agent, or an H2 receptor antagonist (H2RA)] in LDA-associated upper GI injuries. The meta-analysis was performed using RevMan 5.1 software.

Results: We evaluated 8780 participants in 10 RCTs. The meta-analysis showed that PPIs decreased the risk of LDA-associated upper GI ulcers (OR = 0.16; 95%CI: 0.12-0.23) and bleeding (OR = 0.27; 95%CI: 0.16-0.43) compared with control. For patients treated with dual anti-platelet therapy of LDA and clopidogrel, PPIs were able to prevent the LDA-associated GI bleeding (OR = 0.36; 95%CI: 0.15-0.87) without increasing the risk of major adverse cardiovascular events (MACE) (OR = 1.00; 95%CI: 0.76-1.31). PPIs were superior to H2RA in prevention of LDA-associated GI ulcers (OR = 0.12; 95%CI: 0.02-0.65) and bleeding (OR = 0.32; 95%CI: 0.13-0.79).

Conclusion: PPIs are effective in preventing LDA-associated upper GI ulcers and bleeding. Concomitant use of PPI, LDA and clopidogrel did not increase the risk of MACE.

Keywords: Gastrointestinal bleeding; Low dose aspirin; Meta-analyses; Peptic ulcer; Proton pump inhibitor; Randomized controlled trial.

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Figures

Figure 1
Figure 1
Flow chart of the meta-analysis, summarizing retrieved, included and excluded studies. LDA: Low-dose aspirin; NSAID: Nonsteroidal anti-inflammatory drug; RCT: Randomized controlled trials; GI: Gastrointestinal.
Figure 2
Figure 2
Risks of bias graph.
Figure 3
Figure 3
Risks of bias summary.
Figure 4
Figure 4
Comparison of the effects of proton pump inhibitors and control drugs in prevention of low-dose aspirin-associated upper gastrointestinal ulcer. LDA: Low-dose aspirin; PPIs: Proton pump inhibitors.
Figure 5
Figure 5
Comparison of the effects of proton pump inhibitors and 3 different control drugs in prevention of low-dose aspirin-associated upper gastrointestinal ulcer. LDA: Low-dose aspirin; PPIs: Proton pump inhibitors.
Figure 6
Figure 6
Comparison of the effects of proton pump inhibitors and control drugs in prevention of low-dose aspirin-associated upper gastrointestinal bleeding. LDA: Low-dose aspirin; PPIs: Proton pump inhibitors.
Figure 7
Figure 7
Comparison of the effects of proton pump inhibitors and control drugs in prevention of low-dose aspirin-associated upper gastrointestinal bleeding. LDA: Low-dose aspirin; PPIs: Proton pump inhibitors.
Figure 8
Figure 8
Comparison of the preventive effects of proton pump inhibitors and control drugs in the dual anti-platelet medication-associated upper gastrointestinal ulcer. PPIs: Proton pump inhibitors.
Figure 9
Figure 9
Comparison of proton pump inhibitors and control drugs on major adverse cardiovascular events of dual anti-platelet medication. PPIs: Proton pump inhibitors; MACE: Major adverse cardiovascular events.
Figure 10
Figure 10
Funnel plot analysis of proton pump inhibitors and control drugs in prevention of upper gastrointestinal bleeding.
See this image and copyright information in PMC

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