Zusammenfassung
GRUNDLAGEN: In einer Patientenkohorte, welche nach perkutaner koronarer Intervention (PCI) kombinierte Thrombozytenaggregationshemmung (Aspirin und Clopidogrel) erhielt, wurde die Wirksamkeit einer individualisierten PPI-Gabe zur Reduktion unerwünschter gastrointestinaler Ereignisse untersucht. METHODIK: Das gastrointestinale Risikofaktorprofil und andere Parameter wurden aus einer speziell angelegten elektronischen Datenbank extrahiert. Die Patienten wurden via standardisierten Fragebogen kontaktiert und bei Patienten mit unerwünschten gastrointestinalen Ereignissen wurde zusätzlich ein strukturiertes Telefoninterview durchgeführt. ERGEBNISSE: In einer Kohorte von 718 Patienten erhielten 87 (12,1 %) eine prophylaktische PPI-Therapie. Bei insgesamt 12 % wurden unerwünschte gastrointestinale Ereignisse gefunden, wobei 18,4 % eine PPI-Prophylaxe und 11,1 % kein PPI hatten (OR 1,80, P = 0,054). Eine Komedikation mit Steroiden war der hauptsächliche Risikofaktor für unerwünschte gastrointestinale Ereignissen (adjusted OR 5,45, P = 0,014). SCHLUSSFOLGERUNGEN: Die individualisierte PPI-Therapie basierend auf einer Risikoabschätzung für gastrointestinale Blutungsereignisse scheint ein effizientes Instrument zu sein, um gastrointestinale Ereignisse nach PCI zu minimieren.
Summary
BACKGROUND: We investigated the effect of individualised proton pump inhibitors (PPI) prescription on upper gastrointestinal adverse events in a cohort of patients who received combination antiplatelet therapy (aspirin and clopidogrel) after percutaneous coronary intervention (PCI). METHODS: Upper gastrointestinal risk factors and other parameters were extracted from a dedicated electronic database. Patients were contacted with a standardised questionnaire. A structured phone interview was performed in all patients with upper gastrointestinal adverse events. RESULTS: A cohort of 718 patients on combination therapy yielded 87 (12.1%) patients with prophylactic PPI treatment. Upper gastrointestinal adverse events occurred in 18.4% patients with and in 11.1% patients without prophylactic PPI (OR 1.80, P = 0.054). Co-treatment with corticosteroids was the main identifiable risk factor for upper gastrointestinal adverse events (adjusted OR 5.45, P = 0.014). CONCLUSIONS: Individualised prescription of PPI-prophylaxis after PCI in patients on combined antiplatelet therapy based on risk assessment for upper gastrointestinal bleeding seems to represent an effective measure to minimise upper gastrointestinal adverse events after PCI.
References
Silber S, Albertsson P, Aviles FF, et al. Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J, 26: 804–847, 2005
Mehta SR, Yusuf S, Peters RJ, et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet, 358(9281): 527–533, 2001
Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet, 364(9431): 331–337, 2004
McQuaid KR, Laine L. Systematic review and meta-analysis of adverse events of low-dose aspirin and clopidogrel in randomized controlled trials. Am J Med, 119: 624–638, 2006
Laine L. GI risk and risk factors of NSAIDs. J Cardiovasc Pharmacol, 47(Suppl 1): S60–S66, 2006
Byrne MF, Murray FE. Formulary management of proton pump inhibitors. Pharmacoeconomics, 16: 225–246, 1999
Herings RM, Goettsch WG. Inadequate prevention of NSAID-induced gastrointestinal events. Ann Pharmacother, 38: 760–763, 2004
Lanas A, Scheiman J. Low-dose aspirin and upper gastrointestinal damage: epidemiology, prevention and treatment. Curr Med Res Opin, 23: 163–173, 2007
Bhatt DL, Scheiman J, Abraham NS, et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol, 52: 1502–1517, 2008
Ibanez L, Vidal X, Vendrell L, et al. Upper gastrointestinal bleeding associated with antiplatelet drugs. Aliment Pharmacol Ther, 23: 235–242, 2006
Ng FH, Lam KF, Wong SY, et al. Upper gastrointestinal bleeding in patients with aspirin and clopidogrel co-therapy. Digestion, 77: 173–177, 2008
Ng FH, Wong SY, Lam KF, et al. Gastrointestinal bleeding in patients receiving a combination of aspirin, clopidogrel, and enoxaparin in acute coronary syndrome. Am J Gastroenterol, 103: 865–871, 2008
Hsiao FY, Tsai YW, Huang WF, et al. A comparison of aspirin and clopidogrel with or without proton pump inhibitors for the secondary prevention of cardiovascular events in patients at high risk for gastrointestinal bleeding. Clin Ther, 31: 2038–2047, 2009
Ray WA, Murray KT, Griffin MR, et al. Outcomes with concurrent use of clopidogrel and proton-pump inhibitors: a cohort study. Ann Intern Med, 152: 337–345, 2010
O'Donoghue ML, Braunwald E, Antman EM, et al. Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials. Lancet, 374(9694): 989–997, 2009
Hsu PI, Lai KH, Liu CP. Esomeprazole with clopidogrel reduces peptic ulcer recurrence, compared with clopidogrel alone, in patients with atherosclerosis. Gastroenterology, 140: 791–798, 2011
Bhatt DL, Cryer BL, Contant CF, et al. Clopidogrel with or without omeprazole in coronary artery disease. N Engl J Med, 363: 1909–1917, 2010
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Häuptle, R., Weilenmann, D., Schneider, T. et al. Individualised PPI prescription in patients on combination antiplatelet therapy and upper gastrointestinal events after percutaneous coronary intervention: a cohort study. Wien Med Wochenschr 162, 67–73 (2012). https://doi.org/10.1007/s10354-012-0056-5
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10354-012-0056-5
Schlüsselwörter
- Kombinierte Thrombozytenaggregationshemmung
- Proton pump inhibitor-Prophylaxe
- Gastrointestinale Nebenwirkung
- Gastrointestinaler Risikofaktor