The Role of Acid Suppressants in the Prevention of Anticoagulant-Related Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background/Aims: Although acid suppressants are widely used for the prevention or treatment of drug-induced upper gastrointestinal bleeding (GIB), evidence regarding the prevention of anticoagulant-related GIB is scarce. The aim of this study was to evaluate the protective effect of acid suppressants against anticoagulant-related GIB. Methods: A systematic review was conducted of studies that evaluated the protective effect of acid suppressants against anticoagulant-related GIB found in PubMed, the Cochrane library, Embase, and KoreaMed from the date of database inception to April 2018. Random effect model meta-analyses with sensitivity analyses were conducted. The methodological quality of each included publication was evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies. Publication bias was assessed. Results: In total, six nested case-control or cohort studies were identified and analyzed. Proton-pump inhibitors (PPI) had a protective effect against upper GIB in patients on dicumarinics (risk ratio [RR], 0.56; 95% confidence interval [CI], 0.38 to 0.83; I2, 0%); however, the histamine-2 receptor antagonist did not have the same effect (RR, 0.97; 95% CI, 0.52 to 1.81; I2, 0%). Acid suppressants did not have a protective effect against GIB in patients on dabigatran (hazard ratio, 0.78; 95% CI, 0.44 to 1.37; I2, 81.8%). Conclusions: The protective effect of PPIs against dicumarinics-related upper GIB was clear, while there was no evidence supporting the protective effect of acid suppressants against dabigatran-related GIB. However, in the absence of randomized trials demonstrating a lack of bias, solid conclusions cannot be drawn.
Abstract
Background/Aims: Although acid suppressants are widely used for the prevention or treatment of drug-induced upper gastrointestinal bleeding (GIB), evidence regarding the prevention of anticoagulant-related GIB is scarce. The aim of this study was to evaluate the protective effect of acid suppressants against anticoagulant-related GIB. Methods: A systematic review was conducted of studies that evaluated the protective effect of acid suppressants against anticoagulant-related GIB found in PubMed, the Cochrane library, Embase, and KoreaMed from the date of database inception to April 2018. Random effect model meta-analyses with sensitivity analyses were conducted. The methodological quality of each included publication was evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies. Publication bias was assessed. Results: In total, six nested case-control or cohort studies were identified and analyzed. Proton-pump inhibitors (PPI) had a protective effect against upper GIB in patients on dicumarinics (risk ratio [RR], 0.56; 95% confidence interval [CI], 0.38 to 0.83; I2, 0%); however, the histamine-2 receptor antagonist did not have the same effect (RR, 0.97; 95% CI, 0.52 to 1.81; I2, 0%). Acid suppressants did not have a protective effect against GIB in patients on dabigatran (hazard ratio, 0.78; 95% CI, 0.44 to 1.37; I2, 81.8%). Conclusions: The protective effect of PPIs against dicumarinics-related upper GIB was clear, while there was no evidence supporting the protective effect of acid suppressants against dabigatran-related GIB. However, in the absence of randomized trials demonstrating a lack of bias, solid conclusions cannot be drawn.
참고문헌 (35)
- Weitz JI, "New antithrombotic drugs: antithrombotic therapy and prevention of thrombosis, 9th ed. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines", Chest, 141(2 Suppl), pp.e120S~e151S (2012)
- Barnes GD, "National trends in ambulatory oral anticoagulant use", Am J Med, 128, pp.1300~1305 (2015)
- Coleman CI, "Effect of pharmacological therapies for stroke prevention on major gastrointestinal bleeding in patients with atrial fibrillation", Int J Clin Pract, 66, pp.53~63 (2012)
- Miller CS, "Risk of gastrointestinal bleeding in patients taking non-vitamin K antagonist oral anticoagulants : a systematic review and meta-analysis", Clin Gastroenterol Hepatol, 15, pp.1674~1683 (2017)
- Lauffenburger JC, "Predictors of gastrointestinal bleeding among patients with atrial fibrillation after initiating dabigatran therapy", Pharmacotherapy, 35, pp.560~568 (2015)
- Abraham NS, "ACCF", ACG, ACG, pp.AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use, Am J Gastroenterol[DOI]
- Hernández-Díaz S, "Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding", perforation : an overview of epidemiologic studies published in the 1990s, 2000, pp.160, 2093~2099
- Barada K, "Gastrointestinal bleeding in the setting of anticoagulation and antiplatelet therapy", J Clin Gastroenterol, 43, pp.5~12 (2009)
- Moher D, "Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement", Ann Intern Med, 151, pp.264~269 (2009)
- Kim SY, "Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity", J Clin Epidemiol, 66, pp.408~414 (2013)
- Card N, "Applied meta-analysis for social science research" (2012), The Guilford Press
- Higgins JP, "Cochrane handbook for systematic reviews of interventions. Version 5.1.0" (2011), The Cochrane Collaboration
- Higgins JP, "Quantifying heterogeneity in a meta-analysis", Stat Med, 21, pp.1539~1558 (2002)
- Higgins JP, "Measuring inconsistency in meta-analyses", BMJ, 327, pp.557~560 (2003)
- DerSimonian R, "Meta-analysis in clinical trials", Control Clin Trials, 7, pp.177~188 (1986)
- Begg CB, "Operating characteristics of a rank correlation test for publication bias", Biometrics, 50, pp.1088~1101 (1994)
- Egger M, "Bias in meta-analysis detected by a simple, graphical test", BMJ, 315, pp.629~634 (1997)
- Lanas A, "Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with nonsteroidal anti-inflammatory drugs, antiplatelet agents, and anticoagulants", Am J Gastroenterol, 102, pp.507~515 (2007)
- Massó González EL, "Proton pump inhibitors reduce the long-term risk of recurrent upper gastrointestinal bleeding : an observational study", Aliment Pharmacol Ther, 28, pp.629~637 (2008)
- Lin KJ, "Acid suppressants reduce risk of gastrointestinal bleeding in patients on antithrombotic or anti-inflammatory therapy", Gastroenterology, 141, pp.71~79 (2011)
- Chan EW, "Prevention of dabigatran-related gastrointestinal bleeding with gastroprotective agents : a population-based study", Gastroenterology, 149, pp.586~595 (2015)
- Ray WA, "Association of proton pump inhibitors with reduced risk of warfarin-related serious upper gastrointestinal bleeding", Gastroenterology, 151, pp.1105~1112 (2016)
- Ray WA, "Association of oral anticoagulants and proton pump inhibitor cotherapy with hospitalization for upper gastrointestinal tract bleeding", JAMA, 320, pp.2221~2230 (2018)
- Di Minno A, "Antithrombotic drugs, patient characteristics, and gastrointestinal bleeding : clinical translation and areas of research", Blood Rev, 29, pp.335~343 (2015)
- Savarino V, "The appropriate use of proton pump inhibitors(PPIs) : need for a reappraisal", Eur J Intern Med, 37, pp.19~24 (2017)
- Sugano K, "How do we manage serious gastrointestinal adverse events associated with anti-thrombotic therapy", Expert Rev Gastroenterol Hepatol, 9, pp.5~8 (2015)
- Agewall S, "Expert position paper on the use of proton pump inhibitors in patients with cardiovascular disease and antithrombotic therapy", Eur Heart J, 34, pp.1708~1713 (2013)
- Teichert M, "Proton pump inhibitors and the risk of overanticoagulation during acenocoumarol maintenance treatment", Br J Haematol, 153, pp.379~385 (2011)
- Hata M, "Incidence of drug interaction when using proton pump inhibitor and warfarin according to cytochrome P450 2C19(CYP2C19)genotype in Japanese", Thorac Cardiovasc Surg, 63, pp.45~50 (2015)
- Ko D, "Anticoagulation in the older adult : optimizing benefit and reducing risk", Semin Thromb Hemost, 40, pp.688~694 (2014)
- EINSTEIN Investigators, "Oral rivaroxaban for symptomatic venous thromboembolism", N Engl J Med, 363, pp.2499~2510 (2010)
- Granger CB, "Apixaban versus warfarin in patients with atrial fibrillation", N Engl J Med, 365, pp.981~992 (2011)
- Kuwayama T, "Influence of proton pump inhibitors on blood dabigatran concentrations in Japanese patients with non-valvular atrial fibrillation", J Arrhythm, 33, pp.619~623 (2017)
- Bolek T, "The impact of proton pump inhibition on dabigatran levels in patients with atrial fibrillation", Am J Ther, 26, pp.e308~e313 (2019)
- Bolek T, "Proton pump inhibition in patients treated with novel antithrombotic drugs: should we worry about thrombosis?", J Cardiovasc Pharmacol, 72, pp.71~76 (2018)