Should patients prescribed long-term low-dose aspirin receive proton pump inhibitors? Systematic review and meta-analysis
Notice bibliographique
Résumé
Purpose: Several clinical guidelines recommend the use of proton pump inhibitors (PPIs) in patients taking low-dose aspirin. Although co-prescription of PPIs should be justified, most of these guidelines report no or limited supporting data. This study aimed at systematically reviewing the effects of co-administration of PPIs in patients taking low-dose aspirin on the risks of adverse gastrointestinal (GI) and cardiovascular (CV) events, and on patient adherence to aspirin. Methods: We searched PUBMED, EMBASE and Cochrane Central Register of Controlled Trials databases and bibliographies of the retrieved articles in November 2013 for relevant studies. We included randomized controlled trials (RCTs) and observational studies in patients taking low-dose aspirin with and without PPIs. We excluded studies in patients concomitantly taking clopidogrel or any non-steroidal anti-inflammatory drug other than aspirin. Two authors independently reviewed and extracted information from the studies. Main outcomes considered were relative risks (RRs) of peptic ulcer and ulcer complications, myocardial infarction, ischemic stroke and CV-related mortality, and adherence to aspirin prescription associated with co-administration of PPIs. Risk of bias in the observational studies and RCTs was assessed using the Newcastle Ottawa Scale and the Cochrane Collaboration’s tool, respectively. Pooled RRs were computed using a random effects model. Results: We included 13 studies, of which four (cohorts) reported on the effect on peptic ulcer, five (two cohort and three case-control) on GI bleeding, three (two RCTs and one cohort) on both GI bleeding and peptic ulcer, and one (cohort) on both GI bleeding and CV events. No study reported on adherence to aspirin prescription. Co-administration of PPIs in patients receiving low-dose aspirin was associated with risk reductions of 73% (pooled RR [95% CI ] = 0.27 [0.17-0.42]) and of 50% (pooled RR [95% CI ] = 0.50 [ 0.32-0.80]) in the occurrence of peptic ulcer and GI bleeding, respectively (Figure 1). Estimated RRs [95% CI] of myocardial infarction, stroke, and CV death were reported in one study only and were 1.33 [1.13-1.56], 1.20 [0.99-1.46], and 2.19 [1.92-2.49], respectively. There was evidence of bias in publications reporting on peptic ulcers and GI bleeding. Conclusions: The practice of co-prescribing PPIs in patients taking low-dose aspirin is supported by some data, but the evidence is rather weak. It currently remains unclear whether the benefits of co-administration of PPIs in users of low-dose aspirin outweigh their potential harms.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,002 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».