Proton pump inhibitors significantly decreased the risk of low-dose aspirin-associated upper gastrointestinal ulcers (OR 0.16; 95% CI 0.12-0.23) and bleeding (OR 0.27; 95% CI 0.16-0.43).
Meta-Analysis (n=8,780)
Do proton pump inhibitors prevent low-dose aspirin-associated upper gastrointestinal injuries in patients taking low-dose aspirin?
PPIs are highly effective in preventing low-dose aspirin-associated upper GI ulcers and bleeding, without increasing the risk of MACE when used with dual antiplatelet therapy.
Effect estimate: OR 0.16 (95% CI 0.12-0.23)
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.
Mo Chen (Thu,) conducted a meta-analysis in Low-dose aspirin-associated upper gastrointestinal injuries (n=8,780). Proton pump inhibitors (PPIs) vs. Placebo, cytoprotective agent, or H2 receptor antagonist (H2RA) was evaluated on Low-dose aspirin-associated upper gastrointestinal ulcers (OR 0.16, 95% CI 0.12-0.23). Proton pump inhibitors significantly decreased the risk of low-dose aspirin-associated upper gastrointestinal ulcers (OR 0.16; 95% CI 0.12-0.23) and bleeding (OR 0.27; 95% CI 0.16-0.43).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: