Key result
Vonoprazan reduces peptic ulcer risk ~95% vs placebo in patients taking antiplatelet therapy.
Why the study?
The comparative effectiveness of acid-suppressive and gastroprotective agents for preventing gastrointestinal complications in patients with CHD on antiplatelet therapy remains uncertain.
Do acid-suppressive agents and gastric mucosal protectants reduce peptic ulcer occurrence and gastrointestinal bleeding in patients with CHD on antiplatelet therapy?
Meta-Analysis
Do acid-suppressive agents and gastric mucosal protectants reduce peptic ulcer occurrence and gastrointestinal bleeding in patients with CHD on antiplatelet therapy?
Relative Risk: 0.05
Acid-suppressive therapies, particularly P-CABs and PPIs, are superior to gastroprotective agents for preventing gastrointestinal injury in CHD patients receiving antiplatelet therapy.
Supports preferring PPIs or vonoprazan for GI protection in antiplatelet-treated CHD patients; confirms superiority via network meta-analysis of 20 RCTs.
Background Gastrointestinal complications remain an important clinical concern in patients with coronary heart disease (CHD) receiving antiplatelet therapy, and the comparative effectiveness of available acid-suppressive and gastroprotective strategies in this population remains uncertain. Objectives To compare the efficacy of acid-suppressive agents and gastric mucosal protectants for preventing peptic ulcer occurrence and gastrointestinal bleeding in patients with CHD receiving antiplatelet therapy. Design Systematic review and network meta-analysis of randomized controlled trials. Data sources and methods PubMed, Embase, the Cochrane Library, and Ovid MEDLINE were searched from inception to May 29, 2024. Eligible trials enrolled patients receiving antiplatelet therapy, predominantly low-dose aspirin or dual antiplatelet therapy, and compared PPIs, H2RAs, P-CAB, gastric mucosal protectants, or placebo. Relative risks were synthesized using random-effects network meta-analysis, with assessment of risk of bias, inconsistency, transitivity, and small-study effects. Results Twenty randomized controlled trials were included. Acid-suppressive agents were generally more effective than gastroprotective agents in preventing gastrointestinal complications. For peptic ulcer occurrence, the estimated RRs versus placebo were 0.05 for vonoprazan, 0.14 for PPIs, and 0.48 for famotidine, whereas gastroprotective agents showed less consistent protective effects. For gastrointestinal bleeding, vonoprazan also showed favorable trends. However, the evidence for P-CAB was based on a limited number of trials, and its apparent advantage over PPIs should therefore be interpreted cautiously. Conclusion Acid-suppressive therapies may be preferable to gastroprotective agents for preventing gastrointestinal injury in patients with CHD receiving antiplatelet therapy. P-CAB ranked highest in the current network, but this finding should be considered hypothesis-generating until confirmed by adequately powered direct comparative trials against PPIs.
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张宇婕 et al. (2026) conducted a meta-analysis in Coronary heart disease (CHD) receiving antiplatelet therapy. Acid-suppressive agents (vonoprazan, PPIs, famotidine) vs. Placebo and gastroprotective agents was evaluated on Peptic ulcer occurrence (RR 0.05 for vonoprazan, RR 0.14 for PPIs, RR 0.48 for famotidine vs placebo). Acid-suppressive agents effectively prevented peptic ulcers compared to placebo in patients on antiplatelets, with relative risks of 0.05 for vonoprazan, 0.14 for PPIs, and 0.48 for famotidine.
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