Proton Pump Inhibitors In Patients Research Articles

De-Prescribing Proton Pump Inhibitors in Patients With End Stage Kidney Disease: A Quality Improvement Project.

Background:Proton pump inhibitors (PPIs) are widely prescribed and may be associated with harm; hypomagnesemia and reduced effectiveness of calcium carbonate phosphate binders may be important in end-stage kidney disease (ESKD).Objectives:Our objectives included (1) discontinuing PPIs and H2 blockers and (2) assessing the impact on serum magnesium and markers of mineral metabolism.Design:Prospective cohort.Setting:Satellite hemodialysis unit of a tertiary care hospital.Patients:Incident and prevalent patients with ESKD treated with hemodialysis.Measurements:We assessed the impact of stopping PPI/H2 blockers in patients who did not have an absolute indication as per guidelines in the general population; serum magnesium, calcium, and phosphate were measured before and approximately 8 weeks later. Analysis of variance (ANOVA) test and Kruskal-Wallis was used to describe the population. Wilcoxon signed rank test for the paired change scores (from pre to post)Methods:The electronic medical record (EMR) was extensively searched for absolute indications for a PPI. Results were reviewed with the primary nephrology team before approaching patients about stopping the PPI. Basic demographic information and select medications were also collected.Results:Electronic medical records were reviewed for 179 patients, 74 had a PPI or H2 antagonist or both on their medication list (43%); 23 (31%) were assessed as appropriate. After primary team and patient review, 29 patients agreed to a trial of PPI withdrawal. Fourteen patients restarted their PPI, most for gastroesophageal reflux disease. Three patients had a GI bleed, 1 fatally. Serum calcium (P = .17) and the dose of phosphate binders (P = .075) did not change but serum phosphate increased (1.55 [0.29] to 1.85 [0.34] mmol/L; P = .0005). Serum magnesium also increased (1.01 [0.16] to 1.06 [0.14] mmol/L; P = .01).Limitations:Small patient numbers and observational nature of the study does not establish causation in this population at high risk to experience a gastrointestinal bleed.Conclusions:Our results suggest that PPI deprescribing as recommended in the general population may be associated with harm in patients with ESKD and requires further study.Trial Registration:Not registered.

Restoration for the foregut surgery: bridging gaps between foregut surgery practice and academia.

Foregut surgery largely involves benign diseases, and not only malignant diseases. However, for foregut surgeons in Asia, this fact has not been extensively utilized in their clinical practice due to the high burden of gastric cancer surgery. Although the prevalence of gastroesophageal reflux disease (GERD) in Eastern Asia, including Korea, is increasing, antireflux surgery (ARS) is still a fairly rare procedure in Korea. ARS is effective as proton pump inhibitors and is cost-effective compared to continuous double-dose proton pump inhibitors in patients with severe GERD. Therefore, we should focus on ARS as a treatment option for GERD also in Asian population. Similarly, although bariatric/metabolic surgery is effective in weight reduction and diabetes mellitus (DM) remission in patients with morbid obesity or DM, bariatric/metabolic surgery is only performed in a limited number of patients. Given that the prevalence of obesity and DM is continuously increasing in Korea, bariatric/metabolic surgery should become an interest among Korean foregut surgeons and should be considered a treatment for obesity and DM. Furthermore, there are new surgical fields that can control both benign and malignant diseases. Oncometabolic surgery is a field under foregut surgery that treats both malignant and benign components of a condition, an example being the control of metabolic syndrome while performing gastric cancer surgery. Therefore, in future gastric cancer treatment, oncometabolic surgery can be applied to patients with gastric cancer accompanied by obesity or metabolic syndrome.

EP.FRI.557 A systematic review on the use of prophylactic Proton Pump Inhibitors in patients with a hip fracture and their effect on developing acute gastrointestinal haemorrhage and mortality

Abstract Hip fractures represent a significant burden to every Orthopaedic department. Acute gastrointestinal haemorrhage (AGIH) /stress ulceration is a postoperative complication associated with increased mortality. Stress ulcer prophylaxis such as the use of proton pump inhibitors (PPI) is an important measure to decrease this perioperative complication. Aims This systematic review will aim to determine whether there is any benefit for patients with hip fractures being treated with prophylactic PPI medication to prevent AGIH and whether they reduce mortality. Methods A systematic review of the literature was conducted according to PRISMA guidelines. Studies were identified according to the selection criteria and analysed using statistical software. Results A total of 3 observational studies with 3413 participants met the criteria for inclusion. Patients taking PPIs had a reduced risk of an AGIH hip fracture than those without PPI therapy (RR 0.15 (95% CI 0.04–0.57, p < 0.0001).The use of PPIs in hip fracture patients shows a reduced mortality risk (RR 0.12 (95% CI 0.01–1.06, p < 0.0001). Conclusion These results suggest that prophylactic PPI use in hip fracture patients is associated with a reduced risk of AGIH and also a reduced rate of mortality in this patient group. Orthopaedic surgeons should be aware of the risk of AGIH as a complication in hip fracture patients, knowledgeable to the factors which increase risk in their patient population and be cognisant that the prophylactic use of PPI medication is of benefit in reducing the complication of AGIH and correlates with a decreased mortality rate.

498P Association between capecitabine efficacy and proton pump inhibitors in patients with stage II-III colorectal cancer: A retrospective multicenter study

The association between capecitabine efficacy and coadministration of proton pump inhibitors (PPIs) has currently been controversial issue. The present study aimed to clarify whether coadministration of PPIs affects the real-world effectiveness of capecitabine in postoperative patients with early-stage colorectal cancer (CRC) receiving adjuvant chemotherapy.

AB095. SOH21AS250. A systematic review on the use of prophylactic proton pump inhibitors in patients with a hip fracture and their effect on developing acute gastrointestinal haemorrhage and mortality

Background: Hip fractures represent a significant burden to every orthopaedic department. Acute gastrointestinal haemorrhage is a postoperative complication associated with increased mortality. Stress ulcer prophylaxis such as the use of proton pump inhibitors is an important measure to decrease this perioperative complication. There are no guidelines on the prescription of prophylactic proton pump inhibitors (PPIs) to hip fracture patients.

Endoscopic changes in patients diagnosed with acute pancreatitis.

There have been long debates on the introduction of proton pump inhibitors into acute pancreatitis therapy as standard treatment. The aim of the study was to assess endoscopic lesions of the upper gastrointestinal tract in patients hospitalized for acute pancreatitis. We carried out a prospective analysis of patients hospitalized in one surgical center who had an upper gastrointestinal tract endoscopic examination performed during the first 48 hours of hospitalization. We performed analysis of basic descriptive statistics along with the Shapiro-Wilk Test, logistic order regression analysis, One-Way Analysis of Variance, and Student's t-test for independent trials. From January 2016 to December 2019, 476 patients were hospitalized because of acute pancreatitis. The upper gastrointestinal tract endoscopic examination was performed in 85 patients (N.) in the first 48 hours. From the examined group 45 patients (52.94%) developed mild acute pancreatitis, 28 (32.94%) moderate pancreatitis, and 12 (14.12%) severe pancreatitis. Lesions in the endoscopic imaging were observed in 80 patients (94.12%). A very high percentage of patients hospitalized for acute pancreatitis present lesions in the endoscopic imaging of the upper gastrointestinal tract. The standard treatment of AP is the administration of non-steroidal anti-inflammatory drugs, which themselves can cause gastric and duodenal mucosal defects. All these factors indicate the need for standard use of proton pump inhibitors in patients hospitalized for acute pancreatitis.

Risk of major adverse cardiovascular events for concomitant use of clopidogrel and proton pump inhibitors in patients inheriting CYP2C19 loss-of-function alleles: meta-analysis.

Background Efficacy of clopidogrel may be diminished due to either co-administration of proton pump inhibitors or carrying CYP2C19 loss-of-function alleles. However, patients may be at greater risk of major adverse cardiovascular events if taking clopidogrel together with proton pump inhibitors and also inherited the CYP2C19 loss-of-function alleles which may cause further reduction of clopidogrel efficacy. This is due to the cumulative effects of drug-drug interactions and drug-gene interactions collectively referred to as multifactorial drug-gene interactions. Aim of the review The aim of this analysis was to estimate aggregated risk of major adverse cardiovascular events for either coronary heart disease or stroke patients with multifactorial drug-gene interactions versus clopidogrel alone with or without drug-gene interactions. Methods Literatures were searched using different resources based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analysis was performed using RevMan software following either fixed/random effects model based on the levels of heterogeneity. A p value < 0.05 (2-sided) was considered statistically significant. Results In total, five studies consisting 8,802 patients of coronary artery diseases or stroke were included in this meta-analysis in which 3,767 were prescribed clopidogrel alone, 1,931 were concomitantly taking clopidogrel and PPIs, 2,146 were carrying CYP2C19 loss-of-function alleles and 958 were taking both clopidogrel and proton pump inhibitors while also carrying CYP2C19 loss-of-function alleles. It was found that patients with multifactorial drug-gene interactions were associated with significantly increased risk of major adverse cardiovascular events compared to those taking clopidogrel alone without CYP2C19 loss-of-function alleles (12% vs. 5.8%; RR 1.73; 95% CI 1.12-2.67; p = 0.01). Patients with multifactorial drug-gene interactions were also associated with significantly increased risk of major adverse cardiovascular events compared to drug-gene interactions (RR 1.63; 95% CI 1.31-2.03; p < 0.0001). Patients taking clopidogrel with proton pump inhibitors were also associated with 35% significantly increased risk of major adverse cardiovascular events compared to those taking only clopidogrel (RR 1.35; 95% CI 1.11-1.65; p = 0.003). Conclusion Patients inheriting CYP2C19 loss-of-function alleles have significantly increased risk of major adverse cardiovascular events when taking clopidogrel and proton pump inhibitors concurrently.

Concomitant Use of Levothyroxine and Proton Pump Inhibitors in Patients with Primary Hypothyroidism: a Systematic Review.

The aim of this study was to assess the effect of concomitant use of levothyroxine (LT4) and proton pump inhibitors (PPIs) on thyroid-stimulating hormone (TSH) levels in patients with primary hypothyroidism. A systematic review of interventional and observational studies that compared the TSH levels before and after concomitant use of LT4 and PPI was performed. Articles published in English up to September 1, 2019, were included. PubMed, EMBASE, and Cochrane Library databases. Gray literature was also searched in repositories, websites OpenGrey and Google Scholar, and abstracts of major international congresses. Study quality was assessed with the Newcastle-Ottawa quality assessment scale for observational studies and the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool was used. Five thousand twelve discrete articles were identified. Following assessment and application of eligibility criteria, seven studies were included. There was a considerable heterogeneity among the included studies in design, sample size, inclusion and exclusion criteria, treatment regimen, and baseline demographics. Each of the included studies showed an increase in TSH levels following LT4 and PPI consumption, and in the majority of these, the increase was statistically significant. The concomitant use of LT4 and PPI showed a significant increase in TSH concentration. However, given the small number of studies, further research is needed to clarify the interfering role of PPI on LT4 intestinal absorption. CRD42020047084.

Adverse outcomes of proton pump inhibitors in patients with chronic kidney disease: The CKD-REIN cohort study.

Long-term use of proton pump inhibitors (PPIs) has been associated with adverse kidney events in the general population, but their impact among chronic kidney disease (CKD) patients is unclear. We studied the prevalence and incidence (new users) of PPI prescriptions and their relation to kidney outcomes and mortality in CKD patients. We collected drug prescriptions prospectively in a cohort of 3023 nephrology outpatients with CKD stages 2-5 at inclusion. Hazard ratios (HR, 95% confidence intervals [95% CI]) for acute kidney injury (AKI), end-stage kidney disease (ESKD), and mortality associated with new PPI prescriptions as a time-dependent variable were estimated with cause-specific Cox models in 1940 non-users with eGFR≥15mL/min/1.73m2 at baseline, adjusted for comorbidities, laboratory data and drugs. There were 981/3023 (32%) prevalent users (67±13years, 65% men) at baseline, and 366/3023 (12%) were prescribed PPI (new users) over a median follow-up of 3.9years (interquartile range, 3-4.2). Among these new users, their median cumulative duration of prescription was 1year (interquartile range: 0.4-2.3). During follow-up, 354 patients developed ESKD and 216 died before ESKD. The adjusted HRs associated with PPI prescription were 1.74 (95% CI, 1.26-2.40) for ESKD and 2.42 (95% CI, 1.73-3.39) for all-cause mortality. Over the first 3years of follow-up, 211 AKI events had occurred. The adjusted HR for AKI associated with PPI prescription was 2.89 (95% CI, 1.91-4.38). Long-term PPI prescription was common in CKD patients. Our results call attention to its potential risks of both acute and chronic kidney failure.

Feasibility and determinants of deprescription of proton pump inhibitors in patients with typical reflux symptoms

<br><b>Background and Aims:</b> Proton pump inhibitors (PPIs) are commonly used drugs in the management of reflux symptoms. These drugs are frequently overused and have side effects on long term use. The present study was undertaken to determine the feasibility and determinants of deprescription of PPI in patients with typical reflux symptoms. <b>Materials and Methods:</b> This retrospective study recruited all patients, >18 years, with heartburn and/or regurgitation of more than 3-month duration. The severity of reflux was assessed with white light endoscopy and graded as per Los Angeles classification. All patients were advised lifestyle changes, aerobic exercises for >30 min/day, and dietary modifications. Follow-up details, including symptom resolution and drug requirement, were noted at 3 months after the initial visit. <b>Results:</b> A total of 106 patients formed the study cohort (males 60, median age 43 years [range 18–72 years]). Reflux esophagitis was noted in 32 cases (30%). Of these patients, 8 (25%) had Grade A esophagitis and the remaining had Grade B or beyond. Three-fourths of the patients were prescribed once a day PPI. On follow-up at 3 months, PPI therapy was stopped completely in 58 (54.7%) cases. Thirty-two (30.2%) and 16 (15.1%) patients were on on-demand PPI and continuous low dose therapy, respectively. A significantly higher proportion of patients with reflux esophagitis (30/32, 93.75%) could stop PPI at the end of 3 months. The need for on-demand PPI and continuous low dose therapy was higher in patients with nonerosive reflux disease (14 cases, 19%). In univariate analysis, use of alcohol (<i>P</i> = 0.04), smoking (<i>P</i> = 0.0006), presence of diabetes mellitus (<i>P</i> = 0.01), and presence of hiatus on endoscopy (<i>P</i> = 0.03) were the factors significantly associated with continued use of PPI at the end of 3 months. In multivariate analysis, smoking was the only factor independently associated with the continuation of PPI use after 3 months. <b>Conclusion:</b> Deprescription of PPI was achieved in 90 cases (84.9%) at 3 months. In univariate analysis, use of alcohol, smoking, presence of diabetes mellitus, and presence of hiatus are associated with continued PPI use at 3 months. In multivariate analysis, smoking was the only factor independently associated with the continuation of PPI use after 3 months.<br>

Polymorphism of genes is factor efficiency anti ulcer pharmacotherapy

Peptic ulcer disease is one of the variants of the typological response of the body when exogenous factors of the internal environment interact (type of the nervous system, endocrine system, psycho emotional characteristics, metabolism, biochemical reactions, and cytokine profile) with external exogenous factors. This pathology is one of the most common diseases of internal organs, and among the adult population it occurs in 7–12% of cases [1; 2; 3]. Type II stomach ulcers (Johnson H. D., 1965) or combined stomach and duodenal ulcers account for about 25% of the structure of gastric ulcers [7] According to modern research data, up to 10% of residents of Europe, the USA and Russia suffer from this disease (Ivashkin V.T., Minushkin O.N., 2015). In Uzbekistan, about 14% of people develop stomach ulcers; this disease is most common in men. (Https.//nuz.uz Jun 5, 2018) This review article also contains information on the significant effects of gene polymorphisms encoding biotransformation enzymes of drugs on the efficacy and safety of antiulcer pharmacotherapy. Determination of the polymorphism of the CYP3A5 gene makes it possible to initially determine the tactics of treatment with proton pump inhibitors in patients with peptic ulcer disease.

Clinical features and therapeutic responses to proton pump inhibitor in patients with severe reflux esophagitis: A multicenter prospective observational study.

Background and AimIn patients with severe erosive reflux disease (ERD; Los Angeles classification grade C/D) who do not undergo endoscopic examination, insufficient strength and duration of proton pump inhibitor (PPI) therapy may lead to complications such as esophageal bleeding and stenosis. Therefore, to provide a safe and effective treatment for gastroesophageal reflux disease (GERD), we investigated the clinical features of patients with severe ERD and their responses to PPI therapy.MethodsPatients with GERD symptoms received PPI therapy for 4 weeks after endoscopic examination. The patients completed the Gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test questionnaire before and 2 or 4 weeks after PPI treatment. Patient characteristics, presence/absence of coexisting atrophic gastritis (AG) and hiatus hernia (HH), and responses to PPI therapy were compared in patients with GERD among three groups (nonerosive reflux disease, mild ERD [grade A/B], and severe ERD).ResultsThe severe ERD group had a significantly higher proportion of males, higher body mass index, and longer duration of GERD morbidity. Furthermore, the severe ERD group also had a significantly lower incidence of coexisting AG and higher incidence of HH. There was no difference in the severity of GERD before PPI treatment among the three groups. Unexpectedly, the response to PPI therapy was the best in the severe ERD group.ConclusionSufficient strength and period of PPI therapy are required, even if the symptoms show early improvement, when treating GERD patients without performing endoscopy, considering the possibility of severe ERD.

Use of proton pump inhibitors in patients with COVID-19 infection: Are we doing more harm than good?

Purpose: The purpose of this paper was to highlight the use of proton pump inhibitors (PPIs) in the supportive treatment of COVID-19 infection and the potential effects associated with their use.&#x0D; Methodology: This was a theoretical paper.&#x0D; Findings: COVID-19 pandemic has had a profound negative impact worldwide on the economic and healthcare machinery. PPIs are important drugs used as supportive therapy for various medical conditions like heart-burn and acid peptic disease. There is an on-going deliberation regarding the probable useful versus deleterious effects of PPI use in patients with COVID-19 infection. Some authorities believe in their usefulness as anti-oxidant and anti-inflammatory agents, while others prove with evidence the potential harm caused by their use in terms of increased vulnerability to infections. &#x0D; Recommendation: Given their possible side-effects, prudent usage of PPI therapy is warranted in patients with active COVID-19 infection. &#x0D; Keywords: Pandemic, COVID-19, SARS-CoV-2, proton pump inhibitors

Efficacy of a high-dose proton pump inhibitor in patients with gastroesophageal reflux disease: a single center, randomized, open-label trial

BackgroundThe extraesophageal manifestations of gastroesophageal reflux disease (GERD) are more difficult to manage than the typical symptoms. The efficacy of high-dose and standard-dose proton pump inhibitors against these atypical symptoms is not yet established.MethodsIn this single center, randomized, open-label study, patients with GERD received rabeprazole for 8 weeks, either 20 mg once daily (standard-dose group) or 20 mg twice daily (high-dose group). Patients were assessed before treatment and at weeks 4 and 8 with a 5-graded scale questionnaire consisting of 2 typical symptoms (heartburn and acid regurgitation) and 8 atypical symptoms (chest pain, cough, globus, wheezing, laryngopharyngitis, hoarseness, belching, and dysphagia). Sufficient improvement of reflux symptoms was defined as ≥50% reduction from the initial questionnaire score.ResultsFinal analyses included 35 patients in the standard-dose group and 38 patients in the high-dose group. The rate of sufficient improvement for typical symptoms was significantly higher in the high-dose group than in the standard-dose group (100.0% vs. 84.0%, P = 0.040). For atypical symptoms, the rate of sufficient improvement tended to be higher in the high-dose group than in the standard-dose group (82.4% vs. 63.0%, P = 0.087). Scores of typical and some atypical symptoms (cough and globus) improved after treatment, with significant inter-group differences in time-course changes.ConclusionsHigh-dose rabeprazole is more effective for relieving typical GERD symptoms and some atypical symptoms such as cough and globus than a standard-dose regimen.Trial registrationThis research was enrolled in a registry of clinical trials run by United States National Library of Medicine at the National Institutes of Health (ClinicalTrials.gov Protocol Registration and Results system ID: NCT04001400). This study was registered on June 26, 2019 - Retrospectively registered.

Efficacy of Proton Pump Inhibitor in Patients with Non-cardiac Chest Pain

Efficacy of Proton Pump Inhibitor in Patients with Non-cardiac Chest Pain

Assessing the Need for Proton Pump Inhibitors for Patients Using Long-Term Nonsteroidal Anti-inflammatory Drugs without a History of Ulcers

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Discontinuation of Proton Pump Inhibitors in Patients With Chronic Kidney Disease.

Purpose: Proton pump inhibitors (PPIs) are commonly used medications and are historically well tolerated. Recent studies have linked PPI use to the development of chronic kidney disease (CKD) and end-stage renal disease. This study investigated the impact of discontinuing PPIs on renal function in patients with CKD. Methods: We conducted a retrospective chart review of patients with established CKD, defined as 2 eGFR (estimated glomerular filtration rate) measurements of less than 60 mL/min/1.73 m2 at least 90 days apart, who were on a PPI from January 1, 2014 to December 31, 2014, with a medication possession ratio greater than or equal to 70%. We compared baseline eGFR to a final eGFR after at least 6 months of discontinuation or continuation of a PPI. After power analysis, we targeted an enrollment of 200 patients (100 in each group) to achieve a power of 0.80 and an alpha of 0.05. Summary: A total of 97 patients in the PPI discontinuation group and 100 patients in the PPI continuation group met the study inclusion criteria. Baseline eGFR in the PPI continuation group was 47.9 mL/min/1.73 m2 and 50.7 mL/min/1.73 m2 in the discontinuation group. Final eGFR in the PPI continuation group was significantly higher than baseline at 51.1 mL/min/1.73 m2 (+3.25 ± 12.8, P = .01). Final eGFR in the PPI discontinuation group was 51.8 mL/min/1.73 m2 (+1.09 ± 12.8, P = .3). The average time between baseline and final eGFRs was 270 days in the PPI continuation group and 301 days in the discontinuation group. There was no statistically significant difference in the change in eGFRs between groups (95% confidence interval [CI] = -5.48-2.03, P = .37). Conclusions: Proton pump inhibitor discontinuation after prolonged continuous use in patients with CKD was not associated with a significant change in renal function after 1 year.

Prophylactic Use of Mucosal Protective Agents and Proton Pump Inhibitors in Patients Undergoing Percutaneous Coronary Intervention: Real World Evidences of 36,870 Patients.

Prophylactic medications are believed to reduce risks of gastrointestinal (GI) bleeding after percutaneous coronary intervention (PCI). However, their true effectiveness in preventing GI bleeding is still unknown. The clinical data of 36,870 patients treated with PCI from January 2010 to July 2017 were retrospectively analyzed. The trend in the prophylactic use of mucosal protective agents and proton pump inhibitors was analyzed. A total of 36,870 patients were included with a mean age of 60 ± 18 years. In patients treated with primary PCI for ST-segment elevation myocardial infarction, prophylactic medications were associated with a significantly lower incidence of postprocedure GI bleeding in comparison with no medication (1.072%, 52/4852 vs. 2.747%, 25/910; P < 0.001). In patients with CRUSADE scores >40, prophylactic medications were associated with a significantly lower incidence of postprocedure GI bleeding in comparison with not using prophylactic medications (0.679%, 21/3093 vs. 1.899%, 20/1053; P = 0.001). Prophylactic medications were associated with significantly lower incidence of postprocedure 30-day GI bleeding in patients with primary PCI for ST-segment elevation myocardial infarction or CRUSADE scores >40.

Pantoprazole to Prevent Gastroduodenal Events in Patients Receiving Rivaroxaban and/or Aspirin in a Randomized, Double-Blind, Placebo-Controlled Trial.

Antiplatelets and anticoagulants are associated with increased upper gastrointestinal bleeding. We evaluated whether proton pump inhibitor therapy could reduce this risk. We performed a 3× 2 partial factorial double-blind trial of 17,598 participants with stable cardiovascular disease and peripheral artery disease. Participants were randomly assigned to groups given pantoprazole 40 mg daily or placebo, as well as rivaroxaban 2.5 mg twice daily with aspirin 100 mg once daily, rivaroxaban 5 mg twice daily, or aspirin 100 mg alone. The primary outcome was time to first upper gastrointestinal event, defined as a composite of overt bleeding, upper gastrointestinal bleeding from a gastroduodenal lesion or of unknown origin, occult bleeding, symptomatic gastroduodenal ulcer or ≥5 erosions, upper gastrointestinal obstruction, or perforation. There was no significant difference in upper gastrointestinal events between the pantoprazole group (102 of 8791 events) and the placebo group (116 of 8807 events) (hazard ratio, 0.88; 95% confidence interval [CI], 0.67-1.15). Pantoprazole significantly reduced bleeding of gastroduodenal lesions (hazard ratio, 0.52; 95% confidence interval, 0.28-0.94; P= .03); this reduction was greater when we used a post-hoc definition of bleeding gastroduodenal lesion (hazard ratio, 0.45; 95% confidence interval, 0.27-0.74), although the number needed to treat still was high (n= 982; 95% confidence interval, 609-2528). In a randomized placebo-controlled trial, we found that routine use of proton pump inhibitors in patients receiving low-dose anticoagulation and/or aspirin for stable cardiovascular disease does not reduce upper gastrointestinal events, but may reduce bleeding from gastroduodenal lesions. ClinicalTrials.gov ID: NCT01776424.

460 – Effects of Proton-Pump Inhibitors in Patients Receiving Clopidogrel-Based Antithrombotic Therapy for Cardiovascular Prevention: A Systematic Review and Meta-Analysis of Randomized Trials

460 – Effects of Proton-Pump Inhibitors in Patients Receiving Clopidogrel-Based Antithrombotic Therapy for Cardiovascular Prevention: A Systematic Review and Meta-Analysis of Randomized Trials