Adding proton pump inhibitors to dual antiplatelet therapy post-PCI significantly reduced gastrointestinal events (OR 0.22) without increasing major adverse cardiovascular events (OR 0.87).
Does the addition of proton pump inhibitors to dual antiplatelet therapy reduce major adverse cardiovascular events and gastrointestinal events in patients following percutaneous coronary intervention?
2,826 patients following percutaneous coronary intervention (PCI) pooled from 6 RCTs
Proton pump inhibitors (PPIs) as a class, specifically pantoprazole, lansoprazole, and omeprazole, added to dual antiplatelet therapy (DAPT)
Dual antiplatelet therapy (DAPT) without PPIs
Incidence of major adverse cardiovascular events (MACE)composite
Adding PPIs to DAPT in post-PCI patients significantly reduces gastrointestinal events without significantly increasing MACE, though strong CYP2C19 inhibitors like omeprazole should be avoided.
To investigate the effects of proton pump inhibitors (PPIs) on the efficacy of dual antiplatelet therapy (DAPT) in patients following percutaneous coronary intervention (PCI). A computer-based search was conducted in the Cochrane Library, ClinicalTrials.gov, and PubMed databases up to September 30, 2024. Randomized controlled trials (RCTs) evaluating the application of DAPT in conjunction with PPIs in post-PCI patients were included. This network meta-analysis included a total of 6 RCTs with 2,826 participants. The direct meta-analysis of the incidence of major adverse cardiovascular events (MACE) yielded a combined effect size of OR 0.87 (95% CI: 0.71, 1.06). Subgroup analyses by PPI type revealed an OR of 0.85 (95% CI: 0.70, 1.05) for pantoprazole, 0.49 (95% CI: 0.04, 5.59) for lansoprazole, and 1.83 (95% CI: 0.51, 6.53) for omeprazole. For gastrointestinal event incidence, the direct meta-analysis resulted in a combined effect size of OR 0.22 (95% CI: 0.10, 0.46). The ORs for pantoprazole, lansoprazole, and omeprazole were 0.23 (95% CI: 0.07, 0.70), 0.18 (95% CI: 0.02, 1.62), and 0.13 (95% CI: 0.02, 0.73), respectively. The network meta-analysis indicated that the preferred hierarchy for reducing MACE risk is lansoprazole, followed by pantoprazole and omeprazole. In contrast, for minimizing gastrointestinal event risk, the preferred order was omeprazole, followed by lansoprazole and pantoprazole. For patients after PCI, the combination of DAPT and PPIs is recommended to reduce the risks of cardiovascular and gastrointestinal events. Strong CYP2C19 inhibitors such as omeprazole and esomeprazole should be avoided.
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Jing Zhang¹, Xiaoli Hou², Wenxiang Ma¹, *
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Jing Zhang¹, Xiaoli Hou², Wenxiang Ma¹, * (Wed,) reported a other. Adding proton pump inhibitors to dual antiplatelet therapy post-PCI significantly reduced gastrointestinal events (OR 0.22) without increasing major adverse cardiovascular events (OR 0.87).
www.synapsesocial.com/papers/69d896676c1944d70ce07d24 — DOI: https://doi.org/10.5281/zenodo.19467631