| Aims:The role of anti-platelet aggregation in primary and secondary prevention of ischemic disease of heart and head blood-vessel had been confirmed.As the antiplatelet drugs were applied widely,antiplatelet drugs associated upper gastrointestinal mucosal injuries had become significantly rising.How to effectively prevent antiplatelet drugs associated gastrointestinal mucosal injuries had become important subject of clinical study.All randomized controlled trials(RCTs) on PPI preventing antiplatelet drugs associated upper gastrointestinal mucosal injuries were selected,and to determine the preventive effect of PPI in antiplatelet drugs associated upper gastrointestinal mucosal injuries( erosion, ulcer and bleeding),while providing new evidence of evidence-based medicine for clinic.Methods:MEDLINE(via Pubmed), Spinger Link and EMBASE(via Scienc e Direct) database were searched from inception to March 2016.All randomized controlled trials on PPI preventing antiplatelet drugs(aspirin/clopidogrel) associ ated upper gastrointestinal mucousal injuries were checked.The prevention and a dverse effects of PPIs were compared with different control groups(taking plac ebo,gefarnate,famotidine and blank control) on antiplatelet drugs associated uppe r gastrointestinal mucousal injuries.Two researchers independently screened all li teratures,extracted the data and evaluated quality according to inclusion and exc lusion criteria.Meta-analysis was performed using Rev Man5.3 software.Results:A total of 16 studies involving 11083 participants were identified.O ne sample was contained in twelve RCTs,two sample were contained in four R CTs.Therefore,twenty samples were performed in meta-analysis.The results of m eta-analysis show that:on the one hand,PPIs can effectively reduce the risk of aspirin/clopidogrel associated upper gastrointestinal ulcer(OR = 0.17, 95% CI: 0.13 0.21) and bleeding(OR = 0.22, 95% CI: 0.15 0.32) compared with contr ol groups.Furthermore,subgroup analysis showed that:1.the curative effect of PPI in the prevention of antiplatelet drugs associated peptic ulcer was significantly superior to placebo(OR = 0.16, 95% CI: 0.16, 0.24), gefarnate(OR = 0.13, 95% CI: 0.13, 0.23), famotidine(OR = 0.12, 95% CI: 0.12, 0.65),blank control(OR = 0.27, 95% CI: 0.27, 0.39);2.the curative effect of PPI in the prevention of antiplatelet drugs associated gastrointestinal bleeding was also significantly better than placebo(OR = 0.26, 95% CI: 0.26, 0.49),gefarnate(OR = 0.25, 95% CI: 0.25, 0.89), famotidine(OR = 0.31, 95% CI: 0.31, 0.73);3.PPI can effecti vely reduce the risk of aspirin associateded peptic ulcer(OR = 0.15, 95% CI: 0.15, 0.21) and bleeding(OR = 0.17, 95% CI: 0.17, 0.28);4.PPI also can effec tively reduce the risk of dual antiplatelet therapy associated peptic ulcer(OR = 0.26, 95% CI: 0.26, 0.94) and bleeding(OR = 0.33, 95% CI: 0.33, 0.59).On the other hand,PPI combined with antiplatelet drugs did not increase the risk o f adverse cardiovascular events(OR = 0.92, 95% ci: 0.71 1.19).Subgroup analy sis also showed that:no matter whether the long-term using aspirin alone or usi ng a combination of aspirin and clopidogrel,PPI can significantly reduce the in cidence of the cardiovascular adverse events(OR = 0.64, 95% CI: 0.64, 0.64, OR = 1.02, 95% CI: 0.76, 1.36) compared with control groups.In addition,PPI combined with antiplatelet drugs may increase the risk of diarrhea(OR = 1.88, 95% ci: 1.09 3.27).Conclusions:PPI can effectively prevent antiplatelet drugs(aspirin/clopidogrel) associated upper gastrointestinal mucosal ucler and bleeding without increasing the major adverse cardiovascular events(MACE). |
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