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Meta-Analysis
. 2018 Jan;97(3):e9638.
doi: 10.1097/MD.0000000000009638.

Influence of proton pump inhibitors on clinical outcomes in coronary heart disease patients receiving aspirin and clopidogrel: A meta-analysis

Wen Hu  1 , Jin Tong, Xue Kuang, Weijie Chen, Zengzhang Liu
Affiliations
Meta-Analysis

Influence of proton pump inhibitors on clinical outcomes in coronary heart disease patients receiving aspirin and clopidogrel: A meta-analysis

Wen Hu et al. Medicine (Baltimore). 2018 Jan.

Abstract

Background: Proton pump inhibitors (PPIs) are usually prescribed to protect against gastrointestinal bleeding in patients on dual antiplatelet therapy. This meta-analysis reviewed clinical outcomes in patients taking aspirin and clopidogrel, with and without concomitant PPIs to address concerns of adverse reactions.

Methods: We searched PubMed, Embase, and the Cochrane Library for articles published between January 1, 2010 and April 11, 2017. The primary end points were major adverse cardiovascular events and gastrointestinal bleeding. Secondary end points were myocardial infarction, stent thrombosis, revascularization, cardiogenic death, and all-cause mortality.

Results: The meta-analysis included 33,492 patients in 4 randomized controlled trials and 8 controlled observational studies. Overall, patients taking PPIs had statistical differences in major adverse cardiovascular events [odds ratio (OR) 1.17 (95% confidence interval [CI] 1.07-1.28); P = .001; I = 28.3%], gastrointestinal bleeding [OR 0.58 (95% CI 0.36-0.92); P = .022; I = 80.6%], stent thrombosis [OR 1.30 (95% CI 1.01-1.68); P = .041; I = 0%], and revascularization [OR 1.20 (95% CI 1.04-1.38); P = .011; I = 5.1%], compared those not taking PPIs. There were no significant differences in myocardial infarction [OR 1.03 (95% CI 0.87-1.22); P = .742; I = 0%], cardiogenic death [OR 1.09 (95% CI 0.83-1.43); P = .526; I = 0%], or all-cause mortality [OR 1.08 (95% CI 0.93-1.25); P = .329; I = 0%).

Conclusions: Among the patients taking aspirin and clopidogrel, the results indicated that the combined use of PPIs increased the rates of major adverse cardiovascular events, stent thrombosis, and revascularization.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
A flowchart of the trial selection. DAPT = dual antiplatelet therapy.
Figure 2
Figure 2
Risk estimates of major adverse cardiovascular events (MACE). CI = confidence interval, OR = odds ratio, PPI = proton pump inhibitor.
Figure 3
Figure 3
Funnel plot indicating major adverse cardiovascular events (MACE) among patients taking aspirin and clopidogrel with or without proton pump inhibitors (PPIs).
Figure 4
Figure 4
Risk estimates of gastrointestinal (GI) bleeding. CI = confidence interval, OR = odds ratio, PPI = proton pump inhibitor.
Figure 5
Figure 5
Risk estimates of myocardial infarction (MI). CI = confidence interval, OR = odds ratio, PPI = proton pump inhibitor.
Figure 6
Figure 6
Risk estimates of stent thrombosis. CI = confidence interval, OR = odds ratio, PPI = proton pump inhibitor.
Figure 7
Figure 7
Risk estimates of revascularization. CI = confidence interval, OR = odds ratio, PPI = proton pump inhibitor.
Figure 8
Figure 8
Risk estimates of cardiogenic death. CI = confidence interval, OR = odds ratio, PPI = proton pump inhibitor.
Figure 9
Figure 9
Risk estimates of all-cause mortality. CI = confidence interval, OR = odds ratio, PPI = proton pump inhibitor.
See this image and copyright information in PMC

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