Key result
In PCI patients taking clopidogrel, proton pump inhibitors significantly reduced the risk of GI bleeding (OR 3.06; 95% CI 1.89-4.95; P<0.00001) with no significant difference in MACE.
Why the study?
The study was conducted to systematically evaluate the efficacy and safety of proton pump inhibitors combined with clopidogrel in patients undergoing percutaneous coronary intervention.
Does the addition of proton pump inhibitors to clopidogrel reduce gastrointestinal bleeding or impact MACE in patients undergoing percutaneous coronary intervention?
Meta-Analysis (n=9,932)
Does the addition of proton pump inhibitors to clopidogrel reduce gastrointestinal bleeding or impact MACE in patients undergoing percutaneous coronary intervention?
Odds Ratio: 3.06 (95% CI 1.89–4.95)
p-value: p=< 0.00001
In patients undergoing PCI and treated with clopidogrel, the addition of a proton pump inhibitor significantly reduces the risk of gastrointestinal bleeding without increasing the risk of major adverse cardiovascular events.
Supports PPI co-prescription to reduce GI bleeding in clopidogrel-treated PCI patients; confirms MACE neutrality.
Our objective was to systematically evaluate the efficacy and safety of proton pump inhibitors combined with clopidogrel in patients undergoing percutaneous coronary intervention and to provide an evidence basis for clinical treatment decision-making. The database EMBASE, PubMed/Medline, Web of Science, the Cochrane Library and CNKI records from establishment of each database until August 2020 were included. Articles were evaluated for quality. Meta-analysis of selected articles was conducted by RevMan5.3 software. Three RCTs and 4 cohort studies were included, with a total of 9932 patients. Four studies reported gastrointestinal (GI) bleeding events, 3 of which were RCT studies. Overall, there was a significantly lower risk of GI bleeding events in the PPI group compared to the no PPI group [OR = 3.06, 95% CI: 1.89 to 4.95] (P < 0.00001). In 3 RCT studies, there was also a significantly lower risk of GI bleeding events in the PPI group compared to the no PPI group [OR = 3.06, 95% CI: 1.80 to 5.21] (P < 0.0001). Seven studies including 3 RCTs and 4 cohort studies reported MACE. Overall, there was no significant difference in MACE events between PPI group and no PPI group [OR = 1.05, 95% CI: 0.91 to 1.21] (P = 0.50). Both in RCT and cohort studies subgroups, there also was no significant difference in MACE events between the PPI group and the no PPI group [OR = 1.16, 95% CI: 0.87 to 1.53] (P = 0.32), [OR = 1.02, 95% CI: 0.87 to 1.19] (P = 0.84), respectively. For PCI patients taking clopidogrel and PPI therapy, PPI reduced the risk of GI bleeding while having no impact on MACE.
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Han et al. (2021) conducted a meta-analysis in Percutaneous coronary intervention (n=9,932). Proton pump inhibitors vs. No PPI was evaluated on Gastrointestinal (GI) bleeding events (OR 3.06, 95% CI 1.89 to 4.95, p=< 0.00001). In PCI patients taking clopidogrel, proton pump inhibitors significantly reduced the risk of GI bleeding (OR 3.06; 95% CI 1.89-4.95; P<0.00001) with no significant difference in MACE.
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