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Effects of Proton Pump Inhibitors on Cardiovascular Events and Inflammatory Factors in Patients With Upper
Farhan Aslam1, Afaq Naeem2, Emad Munir3
1Orthopedics, Sir Ganga Ram Hospital, Lahore, PAK.
Insights
Proton pump inhibitors (PPIs) do not increase cardiovascular events (CVEs) in patients undergoing dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). PPIs also reduced inflammatory markers like C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α).
Area of Science:
- Cardiology
- Gastroenterology
- Pharmacology
Background:
- Dual antiplatelet therapy (DAPT) is crucial after percutaneous coronary intervention (PCI) to prevent cardiovascular events (CVEs).
- Concomitant use of proton pump inhibitors (PPIs) with DAPT raises concerns regarding bleeding risk and antiplatelet efficacy.
- Optimal co-administration strategies for PPIs and DAPT require further investigation, particularly in patients with upper gastrointestinal bleeding (UGIB).
Purpose of the Study:
- To evaluate the impact of PPIs on CVEs in patients with UGIB undergoing DAPT post-PCI.
- To assess the effect of PPIs on inflammatory factors in this patient population.
- To provide evidence-based recommendations for managing PPIs in DAPT patients with UGIB.
Main Methods:
- Retrospective analysis of 166 patients with UGIB on DAPT after PCI (April 2021-April 2023).
- Patients were divided into two groups: those receiving PPIs and those not.
- Comparison of CVE incidence and serum inflammatory markers (CRP, TNF-α) between groups.
Main Results:
- Melena was the most common UGIB symptom.
- No significant difference in CVE incidence was observed between the PPI and non-PPI groups (P>0.05).
- PPI use was associated with significantly lower serum levels of C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) (P<0.05).
Conclusions:
- PPIs did not increase the risk of CVEs in patients with UGIB on DAPT post-PCI.
- Different PPIs did not influence the occurrence of CVEs.
- PPIs demonstrated a beneficial effect by reducing inflammatory markers (CRP and TNF-α).
Introduction:
Dual antiplatelet therapy (DAPT), vital post-percutaneous coronary intervention (PCI) to prevent cardiovascular events (CVEs) via aspirin and P2Y12 receptor antagonists, faces controversy when combined with proton pump inhibitors (PPIs) due to potential impacts on bleeding risk and antiplatelet efficacy, prompting the need for further research to determine optimal co-administration practices. This work evaluated the effects of PPIs on CVEs and inflammatory factors in patients with upper gastrointestinal bleeding (UGIB) undergoing DAPT after PCI.
Materials And Methods:
The data of 166 patients who underwent PCI and developed UGIB while on DAPT from April 2021 to April 2023 were retrospectively analyzed. The patients were rolled into two groups: those who received PPI treatment and those who did not, namely, the PPI and non-PPI group, respectively. Clinical data from these patients was analyzed, intending to provide relevant theoretical evidence for clinical practice. Furthermore, the occurrence of CVEs and the levels of inflammatory factors of patients in all groups were statistically analyzed.
Results:
Melena was the most common clinical symptom observed in all UGIB patients. The incidence of CVEs in the PPI group was not greatly different from that in the non-PPI group (P>0.05). The distribution of CVEs occurrence among different PPI drugs also exhibited no obvious difference (P>0.05). The PPI group exhibited greatly lower C-reactive protein (CRP) and tumor necrosis factor α (TNF-α) based on the non-PPI group (P<0.05).
Conclusion:
Melena was the most frequent clinical manifestation in UGIB patients. The use of PPIs did not increase the risk of CVEs, and different PPI drugs did not affect the occurrence of CVEs. Furthermore, PPIs lowered CRP and TNF-α levels in serum of these patients.
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