Cargando…
The Role of Acid Suppressants in the Prevention of Anticoagulant-Related Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis
BACKGROUND/AIMS: Although acid suppressants are widely used for the prevention or treatment of drug-induced upper gastrointestinal bleeding (GIB), evidence regarding the prevention of anticoagulant-related GIB is scarce. The aim of this study was to evaluate the protective effect of acid suppressant...
Autores principales: | , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Editorial Office of Gut and Liver
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6974330/ https://www.ncbi.nlm.nih.gov/pubmed/30974930 http://dx.doi.org/10.5009/gnl19009 |
_version_ | 1783490074739998720 |
---|---|
author | Bang, Chang Seok Joo, Moon Kyung Kim, Byung-Wook Kim, Joon Sung Park, Chan Hyuk Ahn, Ji Yong Lee, Jeong Hoon Lee, Bong Eun Yang, Hyo-Joon Cho, Yu Kyung Park, Jae Myung Kim, Beom Jin Jung, Hye-Kyung |
author_facet | Bang, Chang Seok Joo, Moon Kyung Kim, Byung-Wook Kim, Joon Sung Park, Chan Hyuk Ahn, Ji Yong Lee, Jeong Hoon Lee, Bong Eun Yang, Hyo-Joon Cho, Yu Kyung Park, Jae Myung Kim, Beom Jin Jung, Hye-Kyung |
author_sort | Bang, Chang Seok |
collection | PubMed |
description | BACKGROUND/AIMS: Although acid suppressants are widely used for the prevention or treatment of drug-induced upper gastrointestinal bleeding (GIB), evidence regarding the prevention of anticoagulant-related GIB is scarce. The aim of this study was to evaluate the protective effect of acid suppressants against anticoagulant-related GIB. METHODS: A systematic review was conducted of studies that evaluated the protective effect of acid suppressants against anticoagulant-related GIB found in PubMed, the Cochrane library, Embase, and KoreaMed from the date of database inception to April 2018. Random effect model meta-analyses with sensitivity analyses were conducted. The methodological quality of each included publication was evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies. Publication bias was assessed. RESULTS: In total, six nested case-control or cohort studies were identified and analyzed. Proton-pump inhibitors (PPI) had a protective effect against upper GIB in patients on dicumarinics (risk ratio [RR], 0.56; 95% confidence interval [CI], 0.38 to 0.83; I(2), 0%); however, the histamine-2 receptor antagonist did not have the same effect (RR, 0.97; 95% CI, 0.52 to 1.81; I(2), 0%). Acid suppressants did not have a protective effect against GIB in patients on dabigatran (hazard ratio, 0.78; 95% CI, 0.44 to 1.37; I(2), 81.8%). CONCLUSIONS: The protective effect of PPIs against dicumarinics-related upper GIB was clear, while there was no evidence supporting the protective effect of acid suppressants against dabigatran-related GIB. However, in the absence of randomized trials demonstrating a lack of bias, solid conclusions cannot be drawn. |
format | Online Article Text |
id | pubmed-6974330 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Editorial Office of Gut and Liver |
record_format | MEDLINE/PubMed |
spelling | pubmed-69743302020-02-03 The Role of Acid Suppressants in the Prevention of Anticoagulant-Related Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis Bang, Chang Seok Joo, Moon Kyung Kim, Byung-Wook Kim, Joon Sung Park, Chan Hyuk Ahn, Ji Yong Lee, Jeong Hoon Lee, Bong Eun Yang, Hyo-Joon Cho, Yu Kyung Park, Jae Myung Kim, Beom Jin Jung, Hye-Kyung Gut Liver Original Article BACKGROUND/AIMS: Although acid suppressants are widely used for the prevention or treatment of drug-induced upper gastrointestinal bleeding (GIB), evidence regarding the prevention of anticoagulant-related GIB is scarce. The aim of this study was to evaluate the protective effect of acid suppressants against anticoagulant-related GIB. METHODS: A systematic review was conducted of studies that evaluated the protective effect of acid suppressants against anticoagulant-related GIB found in PubMed, the Cochrane library, Embase, and KoreaMed from the date of database inception to April 2018. Random effect model meta-analyses with sensitivity analyses were conducted. The methodological quality of each included publication was evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies. Publication bias was assessed. RESULTS: In total, six nested case-control or cohort studies were identified and analyzed. Proton-pump inhibitors (PPI) had a protective effect against upper GIB in patients on dicumarinics (risk ratio [RR], 0.56; 95% confidence interval [CI], 0.38 to 0.83; I(2), 0%); however, the histamine-2 receptor antagonist did not have the same effect (RR, 0.97; 95% CI, 0.52 to 1.81; I(2), 0%). Acid suppressants did not have a protective effect against GIB in patients on dabigatran (hazard ratio, 0.78; 95% CI, 0.44 to 1.37; I(2), 81.8%). CONCLUSIONS: The protective effect of PPIs against dicumarinics-related upper GIB was clear, while there was no evidence supporting the protective effect of acid suppressants against dabigatran-related GIB. However, in the absence of randomized trials demonstrating a lack of bias, solid conclusions cannot be drawn. Editorial Office of Gut and Liver 2020-01 2019-07-24 /pmc/articles/PMC6974330/ /pubmed/30974930 http://dx.doi.org/10.5009/gnl19009 Text en Copyright © 2020 by The Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Association the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, Korean Pancreatobiliary Association, and Korean Society of Gastrointestinal Cancer. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Bang, Chang Seok Joo, Moon Kyung Kim, Byung-Wook Kim, Joon Sung Park, Chan Hyuk Ahn, Ji Yong Lee, Jeong Hoon Lee, Bong Eun Yang, Hyo-Joon Cho, Yu Kyung Park, Jae Myung Kim, Beom Jin Jung, Hye-Kyung The Role of Acid Suppressants in the Prevention of Anticoagulant-Related Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis |
title | The Role of Acid Suppressants in the Prevention of Anticoagulant-Related Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis |
title_full | The Role of Acid Suppressants in the Prevention of Anticoagulant-Related Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis |
title_fullStr | The Role of Acid Suppressants in the Prevention of Anticoagulant-Related Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis |
title_full_unstemmed | The Role of Acid Suppressants in the Prevention of Anticoagulant-Related Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis |
title_short | The Role of Acid Suppressants in the Prevention of Anticoagulant-Related Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis |
title_sort | role of acid suppressants in the prevention of anticoagulant-related gastrointestinal bleeding: a systematic review and meta-analysis |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6974330/ https://www.ncbi.nlm.nih.gov/pubmed/30974930 http://dx.doi.org/10.5009/gnl19009 |
work_keys_str_mv | AT bangchangseok theroleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT joomoonkyung theroleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT kimbyungwook theroleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT kimjoonsung theroleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT parkchanhyuk theroleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT ahnjiyong theroleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT leejeonghoon theroleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT leebongeun theroleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT yanghyojoon theroleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT choyukyung theroleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT parkjaemyung theroleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT kimbeomjin theroleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT junghyekyung theroleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT theroleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT bangchangseok roleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT joomoonkyung roleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT kimbyungwook roleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT kimjoonsung roleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT parkchanhyuk roleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT ahnjiyong roleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT leejeonghoon roleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT leebongeun roleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT yanghyojoon roleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT choyukyung roleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT parkjaemyung roleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT kimbeomjin roleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT junghyekyung roleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis AT roleofacidsuppressantsinthepreventionofanticoagulantrelatedgastrointestinalbleedingasystematicreviewandmetaanalysis |