Randomized clinical trial: The impact of gastrointestinal risk factor screening and prophylactic proton pump inhibitor therapy in patients receiving dual antiplatelet therapy

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Abstract

Objective Dual antiplatelet therapy reduces the risk of ischemic complications after acute coronary syndrome, but increases the risk of bleeding including upper gastrointestinal bleeding (UGIB). The aim of this study was to examine the effect of screening for risk of UGIB and prophylactic proton pump inhibitor (PPI) treatment in dual-antiplatelet-treated patients at risk of UGIB and to assess the significance of dual antiplatelet therapy compliance for cardiovascular events. Patients and methods In a register-based randomized-controlled trial, 2009 patients were included at the time of first percutaneous coronary intervention and randomized to either screening or control. Screened high-risk patients were prescribed pantoprazole 40 mg during the 1-year after percutaneous coronary intervention. Results The incidence of UGIB was 0.8 versus 1.3% in screened patients and controls, respectively (P=0.381). Significantly fewer screened patients (5.4%) than controls (8.0%) underwent upper gastrointestinal endoscopy (P=0.026). Screened patients (2.9%) had significantly fewer events of unstable angina pectoris than controls (4.7%) (P=0.036) and a higher compliance to dual antiplatelet therapy (88.3 vs. 85.0%) (P=0.035), but no statistically difference was observed in the incidences of myocardial infarction and all-cause mortality (1.0 vs. 1.5%) (P=0.422). Conclusion Screening for risk factors for UGIB and subsequent prophylactic PPI treatment did not significantly reduce the incidence of UGIB. Prescription of PPI was associated with a higher compliance with dual antiplatelet therapy and decreases the risk of recurrent cardiovascular events.

Original languageEnglish
JournalEuropean Journal of Gastroenterology and Hepatology
Volume29
Issue number10
Pages (from-to)1118-1125
ISSN0954-691X
DOIs
Publication statusPublished - 2017

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Randomized Controlled Trials
Incidence
Acute Coronary Syndrome
Prescriptions

Keywords

  • dual antiplatelet therapy
  • proton pump inhibitor
  • upper gastrointestinal bleeding

Cite this

@article{495fdf8913654d818145233b10c850c5,
title = "Randomized clinical trial: The impact of gastrointestinal risk factor screening and prophylactic proton pump inhibitor therapy in patients receiving dual antiplatelet therapy",
abstract = "Objective Dual antiplatelet therapy reduces the risk of ischemic complications after acute coronary syndrome, but increases the risk of bleeding including upper gastrointestinal bleeding (UGIB). The aim of this study was to examine the effect of screening for risk of UGIB and prophylactic proton pump inhibitor (PPI) treatment in dual-antiplatelet-treated patients at risk of UGIB and to assess the significance of dual antiplatelet therapy compliance for cardiovascular events. Patients and methods In a register-based randomized-controlled trial, 2009 patients were included at the time of first percutaneous coronary intervention and randomized to either screening or control. Screened high-risk patients were prescribed pantoprazole 40 mg during the 1-year after percutaneous coronary intervention. Results The incidence of UGIB was 0.8 versus 1.3{\%} in screened patients and controls, respectively (P=0.381). Significantly fewer screened patients (5.4{\%}) than controls (8.0{\%}) underwent upper gastrointestinal endoscopy (P=0.026). Screened patients (2.9{\%}) had significantly fewer events of unstable angina pectoris than controls (4.7{\%}) (P=0.036) and a higher compliance to dual antiplatelet therapy (88.3 vs. 85.0{\%}) (P=0.035), but no statistically difference was observed in the incidences of myocardial infarction and all-cause mortality (1.0 vs. 1.5{\%}) (P=0.422). Conclusion Screening for risk factors for UGIB and subsequent prophylactic PPI treatment did not significantly reduce the incidence of UGIB. Prescription of PPI was associated with a higher compliance with dual antiplatelet therapy and decreases the risk of recurrent cardiovascular events.",
keywords = "dual antiplatelet therapy, proton pump inhibitor, upper gastrointestinal bleeding",
author = "Jensen, {Berit E.S.} and Hansen, {Jane M.} and Larsen, {Kasper S.} and Junker, {Anders B.} and Lassen, {Jens F.} and Jensen, {Svend E.} and {Schaffalitzky De Muckadell}, {Ove B.}",
year = "2017",
doi = "10.1097/MEG.0000000000000934",
language = "English",
volume = "29",
pages = "1118--1125",
journal = "European Journal of Gastroenterology and Hepatology",
issn = "0954-691X",
publisher = "Lippincott Williams & Wilkins, Ltd.",
number = "10",

}

TY - JOUR

T1 - Randomized clinical trial

T2 - The impact of gastrointestinal risk factor screening and prophylactic proton pump inhibitor therapy in patients receiving dual antiplatelet therapy

AU - Jensen, Berit E.S.

AU - Hansen, Jane M.

AU - Larsen, Kasper S.

AU - Junker, Anders B.

AU - Lassen, Jens F.

AU - Jensen, Svend E.

AU - Schaffalitzky De Muckadell, Ove B.

PY - 2017

Y1 - 2017

N2 - Objective Dual antiplatelet therapy reduces the risk of ischemic complications after acute coronary syndrome, but increases the risk of bleeding including upper gastrointestinal bleeding (UGIB). The aim of this study was to examine the effect of screening for risk of UGIB and prophylactic proton pump inhibitor (PPI) treatment in dual-antiplatelet-treated patients at risk of UGIB and to assess the significance of dual antiplatelet therapy compliance for cardiovascular events. Patients and methods In a register-based randomized-controlled trial, 2009 patients were included at the time of first percutaneous coronary intervention and randomized to either screening or control. Screened high-risk patients were prescribed pantoprazole 40 mg during the 1-year after percutaneous coronary intervention. Results The incidence of UGIB was 0.8 versus 1.3% in screened patients and controls, respectively (P=0.381). Significantly fewer screened patients (5.4%) than controls (8.0%) underwent upper gastrointestinal endoscopy (P=0.026). Screened patients (2.9%) had significantly fewer events of unstable angina pectoris than controls (4.7%) (P=0.036) and a higher compliance to dual antiplatelet therapy (88.3 vs. 85.0%) (P=0.035), but no statistically difference was observed in the incidences of myocardial infarction and all-cause mortality (1.0 vs. 1.5%) (P=0.422). Conclusion Screening for risk factors for UGIB and subsequent prophylactic PPI treatment did not significantly reduce the incidence of UGIB. Prescription of PPI was associated with a higher compliance with dual antiplatelet therapy and decreases the risk of recurrent cardiovascular events.

AB - Objective Dual antiplatelet therapy reduces the risk of ischemic complications after acute coronary syndrome, but increases the risk of bleeding including upper gastrointestinal bleeding (UGIB). The aim of this study was to examine the effect of screening for risk of UGIB and prophylactic proton pump inhibitor (PPI) treatment in dual-antiplatelet-treated patients at risk of UGIB and to assess the significance of dual antiplatelet therapy compliance for cardiovascular events. Patients and methods In a register-based randomized-controlled trial, 2009 patients were included at the time of first percutaneous coronary intervention and randomized to either screening or control. Screened high-risk patients were prescribed pantoprazole 40 mg during the 1-year after percutaneous coronary intervention. Results The incidence of UGIB was 0.8 versus 1.3% in screened patients and controls, respectively (P=0.381). Significantly fewer screened patients (5.4%) than controls (8.0%) underwent upper gastrointestinal endoscopy (P=0.026). Screened patients (2.9%) had significantly fewer events of unstable angina pectoris than controls (4.7%) (P=0.036) and a higher compliance to dual antiplatelet therapy (88.3 vs. 85.0%) (P=0.035), but no statistically difference was observed in the incidences of myocardial infarction and all-cause mortality (1.0 vs. 1.5%) (P=0.422). Conclusion Screening for risk factors for UGIB and subsequent prophylactic PPI treatment did not significantly reduce the incidence of UGIB. Prescription of PPI was associated with a higher compliance with dual antiplatelet therapy and decreases the risk of recurrent cardiovascular events.

KW - dual antiplatelet therapy

KW - proton pump inhibitor

KW - upper gastrointestinal bleeding

U2 - 10.1097/MEG.0000000000000934

DO - 10.1097/MEG.0000000000000934

M3 - Journal article

C2 - 28678044

AN - SCOPUS:85021827338

VL - 29

SP - 1118

EP - 1125

JO - European Journal of Gastroenterology and Hepatology

JF - European Journal of Gastroenterology and Hepatology

SN - 0954-691X

IS - 10

ER -