Proton Pump Inhibitors Prevent And Treat Gastrointestinal Bleeding Caused By Double-antibody Treatment After PCI Efficacy And Safety

Background: In recent years,with the widespread use of percutaneous coronary interventions(PCI)in clinical practice,dual antiplatelet therapy with clopidogrel and aspirin(DAPT)has become the standard of treatment for the prevention of stent thrombosis after PCI.However,more and more clinical studies have found that although DAPT can greatly reduce the occurrence of postoperative cardiovascular and cerebrovascular adverse events,gastrointestinal bleeding has become one of its serious complications.The combination of proton pump inhibitor(PPI)can effectively prevent gastrointestinal bleeding,but some studies have suggested that PPI can affect the antiplatelet therapy of clopidogrel,thereby increasing the incidence of major adverse cardiovascular events(MACE),so Whether PPI is routinely used in anti-treatment patients,and how to choose PPI is still controversial.Objective:To evaluate the efficacy and the impact on cardiovascular adverse events of different proton pump inhibitors in preventing gastrointestinal bleeding that is caused by double-antibody treatment after percutaneous coronary intervention by utilizing mesh Meta-analysis.Methods: PubMed,Embase,Cochrane Library,China Knowledge Network,VIP database,Wanfang database were retrieved by computer.The retrieval time was from the establishment of the database to May 1,2018.Document screening,data extraction and quality evaluation were conducted according to the criteria of inclusion and exclusion,For the standard-compliant studies,mesh Meta-analysis was performed by adopting Stata14.0 software.Statistical analysis was performed using odds ratio(OR)and 95% confidence interval,and inconsistency test was performed by calculating Relative Odds Ratio(ROR).Finally,the results of mesh meta-analysis were sorted by Surface under the cumulative ranking(SUCRA)for the efficacy of various interventions.The more SUCRA value High,suggesting that the effect of the intervention may be better and plotting the results.Results: A total of 31 articles were included in the study,including 5 in English and 26 in Chinese.A total of 15091 patients participated in the validity study,including 4151(27.5%)in the omeprazole group,1789(11.9%)in the pantoprazole group,and 177(1.2%)in the rabeprazole group.There were 317 cases(2.1%)in the lansoprazole group,1563 cases(10.4%)in the esomeprazole group,and 7094 cases(47.0%)in the control group.The results of reticular meta-analysis showed that fordifferent PPI prevention of gastrointestinal bleeding caused by double-antibody treatment after PCI,the comparison of various interventions,the six interventions were compared 15 times,of which pantoprazole with omeprazole(OR=1.04,95%CI:0.63~1.74),rabeprazole and omeprazole(OR=0.34,95% CI: 0.09~1.24),lansoprazole and omeprazole There was no statistically significant difference between the two groups(OR=1.08,95% CI: 0.19~6.25),and esomeprazole was better than omeprazole(OR=0.44,95%CI: 0.22~0.89),omeprazole was superior to the control group(OR=3.08,95%CI: 2.15~4.43).Differences between rabeprazole and pantoprazole(OR=0.33,95%CI: 0.09~1.22),lansoprazole and pantoprazole(OR=1.03,95%CI:0.17~6.10)Not statistically significant,and esomeprazole was superior to pantoprazole(OR=0.42,95%CI: 0.19~0.90),and pantoprazole was superior to the control group(OR=2.95,95%CI: 1.89~4.61).Comparison of lansoprazole with rabeprazole(OR=3.17,95%CI: 0.38~26.43),esomeprazole and rabeprazole(OR=1.29,95%CI:0.32~5.18)The difference was not statistically significant,and rabeprazole was superior to the control group(OR=9.07,95% CI: 2.62~31.42).There was no difference between esomeprazole and lansoprazole(OR=0.41,95% CI: 0.06~2.54),control group and lansoprazole(OR=2.86,95%CI: 0.51~15.98).Statistical significance.Esomeprazole was superior to the control group(OR=7.05,95% CI: 3.75~13.29).The results of different interventions for gastrointestinal bleeding were rabeprazole >esomeprazole > lansoprazole > omeprazole > pantoprazole.For the different PPI prevention of adverse cardiovascular events caused by double-antibody treatment after PCI,the comparison of various interventions,the six interventions were also compared 15 times,of which pantoprazole and omeprazole(OR=0.86,95%CI: 0.67~1.10),rabeprazole and omeprazole(OR=0.98,95%CI:0.27~3.62),lansoprazole and omeprazole(OR=0.48,95%CI: 0.04~5.52),esomeprazole and omeprazole(OR=1.00,95%CI: 0.68~1.46),control group and omeprazole(OR=0.98,95% CI: 0.80~1.20)There was no statistically significant difference between the two groups;rabeprazole and pantoprazole(OR=1.14,95% CI:0.31~4.21),lansoprazole and pantoprazole(OR=0.56,95%CI: 0.05~6.43),esomeprazole and pantoprazole(OR=1.16,95%CI: 0.78~1.74),control group and pantoprazole(OR=1.14,95%CI: 0.95~1.38)There was no statistically significant difference between the two;lansoprazole and rabeprazole(OR=0.49,95%CI:0.03~7.70),esomeprazole and rabeprazole(OR=1.02,95%CI: 0.27~3.90),control group and rabeprazole(OR=1.00,95%CI: 0.27~3.64)There was no statisticallysignificant difference between the two groups;esomeprazole and lansoprazole(OR=2.08,95% CI: 0.18~24.50),control group and lansoprazole(OR=2.05,95%CI:0.18~23.41),the difference between the control group and esomeprazole(OR=0.98,95% CI: 0.68~1.41)was also not statistically significant.It can be seen that the results of the reticular meta-analysis between the two interventions suggest that there is no statistically significant difference in the adverse cardiovascular events.Conclusion: Rabeprazole can effectively reduce the incidence of gastrointestinal bleeding caused by double-antibody treatment after PCI,and is superior to other types of proton pump inhibitors in different PPI for prevention of gastrointestinal bleeding caused by double-antibody treatment after PCI.At the same time,the incidence of adverse cardiovascular events was not increased,and there was no statistically significant difference compared with the other PPIs.