Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2015; 21(17): 5382-5392
Published online May 7, 2015. doi: 10.3748/wjg.v21.i17.5382
Proton pump inhibitors in prevention of low-dose aspirin-associated upper gastrointestinal injuries
Chen Mo, Gang Sun, Ming-Liang Lu, Li Zhang, Yan-Zhi Wang, Xi Sun, Yun-Sheng Yang
Chen Mo, Gang Sun, Ming-Liang Lu, Li Zhang, Yan-Zhi Wang, Xi Sun, Yun-Sheng Yang, Institute of Digestive Diseases, the Chinese PLA General Hospital, the Chinese PLA Medical Academy, Beijing 100853, China
Chen Mo, No. 2 Cadre Ward, the General Hospital of Armed Force Police, Beijing 100039, China
Author contributions: Mo C and Yang YS designed the research; Mo C, Lu ML, Zhang L and Wang YZ performed the research; Mo C, Sun G and Sun X analyzed the data; and Mo C wrote the paper.
Conflict-of-interest: The authors declare that they have no conflict-of-interest in this study.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yun-Sheng Yang, MD, PhD, Institute of Digestive Diseases, the Chinese PLA General Hospital, the Chinese PLA Medical Academy, Beijing 100853, China. sunny301ddc@126.com
Telephone: +86-10-55499005 Fax: +86-10-55499005
Received: September 26, 2014
Peer-review started: September 29, 2014
First decision: October 14, 2014
Revised: December 25, 2014
Accepted: January 30, 2015
Article in press: January 30, 2015
Published online: May 7, 2015
Processing time: 228 Days and 14 Hours
Abstract

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.

Keywords: Proton pump inhibitor; Low dose aspirin; Peptic ulcer; Gastrointestinal bleeding; Meta-analyses; Randomized controlled trial

Core tip: Ten randomized controlled trials on the preventive effect and safety of proton pump inhibitors (PPIs) in low-dose aspirin (LDA)-associated gastrointestinal tract injuries were included in this meta-analysis. Based on the data collected and presented, the authors conclude that PPIs are effective in preventing LDA-associated upper gastrointestinal tract ulcers and bleeding, without increasing the risk of major adverse cardiovascular events. The findings further confirm and extend the observations already published.