消化性溃疡史患者中小剂量阿司匹林相关的胃肠损伤预防性治疗的系统评价与Meta分析

Abstract
Figure/Table
References (40)
Related Citation (15)

Download: PDF (1458 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To demonstrate the efficacy of proton pump inhibitors (PPIs) and control drugs in the prevention of low dose Aspirin (LDA) related gastrointestinal (GI) injuries in patients with peptic ulcer history, thus reducing the abuse of PPIs. Methods By searching PubMed, Cochrane Library and Embase database upto May 2018, the randomized controlled trials on the efficacy of preventive therapy [PPIs, H2 receptor antagonist (H2RA), Vonoprazan, and gastric mucosal protective agents] in reducing the risks of GI events in patients taking long term LDA were collected. Results A total of 9 studies were included with a total of 3067 patients. PPIs were superior to placebo and gastric mucosal protective agents in preventing ulcer recurrence and upper gastrointestinal bleeding (UGIB). Vonoprazan (OR = 2.61, 95%CI: 0.81-8.41) and H2RA (OR = 0.36, 95%CI: 0.04-3.54) showed similar efficacy to PPIs in preventing peptic ulcer recurrence. As for prevention of UGIB, Vonoprazan was superior to PPIs, while H2RA was inferior to that of PPIs. In patients with a history of Hp-induced upper GI hemorrhage, Hp eradication treatment had a similar prophylactic effect as PPIs. Conclusion The results suggest that Vonoprazan and H2RA are as effective as PPIs for the prevention of recurrent peptic ulcer, and Vonoprazan exhibits better efficacy for the prevention of UGIB with PPIs. In patients with a history of Hp infection, the eradication treatment has a similar effect as PPIs. Hence, PPIs may not be the best choice for the prevention of LDA associated GI injures.

Key words： Low dose Aspirin Peptic ulcer history Prevention Systematic review Meta analysis

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	WAN Ning1 ZHANG Tiantian2 DONG Yanmin3 JI Bo1

Cite this article:

WAN Ning1 ZHANG Tiantian2 DONG Yanmin3 JI Bo1. Systematic review and Meta-analysis of preventive treatment for low-dose Aspirin-associated gastrointestinal injury in patients with history of peptic ulcer[J]. 中国医药导报, 2019, 16(3): 109-114,135.

URL:

http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2019/V16/I3/109

[1] Berger JS，Lala A，Krantz MJ，et al. Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease：a meta-analysis of randomized trials [J]. Am Heart J，2011，162（1）：115-124.
[2] Antithrombotic Trialists C. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death，myocardial infarction，and stroke in high risk patients [J]. BMJ，2002，324（7329）：71-86.
[3] Chan AT，Manson JE，Feskanich D，et al. Long-term aspirin use and mortality in women [J]. Arch Intern Med，2007，167（6）：562-572.
[4] Iwamoto J，Saito Y，Honda A，et al. Clinical features of gastroduodenal injury associated with long-term low-dose aspirin therapy [J]. World J Gastroenterol，2013，19（11）：1673-1682.
[5] Sung JJ，Kuipers EJ，El-Serag HB. Systematic review：the global incidence and prevalence of peptic ulcer disease [J]. Aliment Pharmacol Ther，2009，29（9）：938-946.
[6] Taha AS，Angerson WJ，Prasad R，et al. Clinical trial：the incidence and early mortality after peptic ulcer perforation，and the use of low-dose aspirin and nonsteroidal anti-inflammatory drugs [J]. Aliment Pharmacol Ther，2008， 28（7）：878-885.
[7] Fujinami H，Kudo T，Hosokawsa A，et al. A study of the changes in the cause of peptic ulcer bleeding [J]. World J Gastrointest Endosc，2012，4（7）：323-327.
[8] Garcia Rodriguez LA，Hernandez-Diaz S，de Abajo FJ. Association between aspirin and upper gastrointestinal complications：systematic review of epidemiologic studies [J]. Br J Clin Pharmacol，2001，52（5）：563-571.
[9] Derry S，Loke YK. Risk of gastrointestinal haemorrhage with long term use of aspirin：meta-analysis [J]. BMJ，2000，321（7270）：1183-1187.
[10] McQuaid KR，Laine L. Systematic review and meta-analysis of adverse events of low-dose aspirin and clopidogrel in randomized controlled trials [J]. Am J Med，2006， 119（8）：624-638.
[11] Laine L. Review article：gastrointestinal bleeding with low-dose aspirin - what's the risk? [J]. Aliment Pharmacol Ther，2006，24（6）：897-908.
[12] Ng FH，Wong SY，Lam KF，et al. Famotidine is inferior to pantoprazole in preventing recurrence of aspirin-related peptic ulcers or erosions [J]. Gastroenterology，2010， 138（1）：82-88.
[13] Chan FK，Kyaw M，Tanigawa T，et al. Similar Efficacy of Proton-Pump Inhibitors vs H2-Receptor Antagonists in Reducing Risk of Upper Gastrointestinal Bleeding or Ulcers in High-Risk Users of Low-Dose Aspirin [J]. Gastroenterology，2017，152（1）：105-110 e101.
[14] Forgacs I，Loganayagam A. Overprescribing proton pump inhibitors [J]. BMJ，2008，336（7634）：2-3.
[15] Earnshaw SR，Scheiman J，Fendrick AM，et al. Cost-utility of aspirin and proton pump inhibitors for primary prevention [J]. Arch Intern Med，2011，171（3）：218-225.
[16] Sarkar M，Hennessy S，Yang YX. Proton-pump inhibitor use and the risk for community-acquired pneumonia [J]. Ann Intern Med，2008，149（6）：391-398.
[17] Washio E，Esaki M，Maehata Y，et al. Proton Pump Inhibitors Increase Incidence of Nonsteroidal Anti-Inflammatory Drug-Induced Small Bowel Injury：A Randomized，Placebo-Controlled Trial [J]. Clin Gastroenterol Hepatol，2016，14（6）：809-815.
[18] Cheung KS，Chan EW，Wong AYS，et al. Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori：a population-based study [J]. Gut，2018，67（1）：28-35.
[19] Hori Y，Imanishi A，Matsukawa J，et al. 1-[5-（2-Fluorophenyl）-1-（pyridin-3-ylsulfonyl）-1H-pyrrol-3-yl]-N-methylmethanamine monofumarate（TAK-438），a novel and potent potassium-competitive acid blocker for the treatment of acid-related diseases [J]. J Pharmacol Exp Ther，2010，335（1）：231-238.
[20] Shin JM，Inatomi N，Munson K，et al. Characterization of a novel potassium-competitive acid blocker of the gastric H，K-ATPase，1-[5-（2-fluorophenyl）-1-（pyridin-3-ylsulfonyl）-1H-pyrrol-3-yl]-N-methylmethanamine monofumarate（TAK-438）[J]. J Pharmacol Exp Ther，2011，339（2）：412-420.
[21] Matsukawa J，Hori Y，Nishida H，et al. A comparative study on the modes of action of TAK-438，a novel potassium-competitive acid blocker，and lansoprazole in primary cultured rabbit gastric glands [J]. Biochem Pharmacol，2011，81（9）：1145-1151.
[22] Sakurai Y，Nishimura A，Kennedy G，et al. Safety，Tolerability，Pharmacokinetics，and Pharmacodynamics of Single Rising TAK-438（Vonoprazan）Doses in Healthy Male Japanese/non-Japanese Subjects [J]. Clin Transl Gastroenterol，2015，6：e94.
[23] Sakurai Y，Mori Y，Okamoto H，et al. Acid-inhibitory effects of vonoprazan 20 mg compared with esomeprazole 20 mg or rabeprazole 10 mg in healthy adult male subjects--a randomised open-label cross-over study [J]. Aliment Pharmacol Ther，2015，42（6）：719-730.
[24] Kawai T，Oda K，Funao N，et al. Vonoprazan prevents low-dose aspirin-associated ulcer recurrence：randomised phase 3 study [J]. Gut，2018，67（6）：1033-1041.
[25] Sugano K，Choi MG，Lin JT，et al. Multinational，double-blind，randomised，placebo-controlled，prospective study of esomeprazole in the prevention of recurrent peptic ulcer in low-dose acetylsalicylic acid users：the LAVENDER study [J]. Gut，2014，63（7）：1061-1068.
[26] Iwakiri R，Higuchi K，Kato M，et al. Randomised clinical trial：prevention of recurrence of peptic ulcers by rabeprazole in patients taking low-dose aspirin [J]. Aliment Pharmacol Ther，2014，40（7）：780-795.
[27] Sanuki T，Fujita T，Kutsumi H，et al. Rabeprazole reduces the recurrence risk of peptic ulcers associated with low-dose aspirin in patients with cardiovascular or cerebrovascular disease：a prospective randomized active-controlled trial [J]. J Gastroenterol，2012，47（11）：1186-1197.
[28] Lai KC，Lam SK，Chu KM，et al. Lansoprazole for the prevention of recurrences of ulcer complications from long-term low-dose aspirin use [J]. N Engl J Med，2002， 346（26）：2033-2038.
[29] Sugano K，Matsumoto Y，Itabashi T，et al. Lansoprazole for secondary prevention of gastric or duodenal ulcers associated with long-term low-dose aspirin therapy：results of a prospective，multicenter，double-blind，randomized，double-dummy，active-controlled trial [J]. J Gastroenterol，2011，46（6）：724-735.
[30] Chan FK，Chung SC，Suen BY，et al. Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen [J]. N Engl J Med，2001，344（13）：967-973.
[31] Bhatt DL，Scheiman J，Abraham NS，et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use：a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents [J]. Circulation，2008，118（18）：1894-1909.
[32] Mo C，Sun G，Lu ML，et al. Proton pump inhibitors in prevention of low-dose aspirin-associated upper gastrointestinal injuries [J]. World J Gastroenterol，2015，21（17）：5382-5392.
[33] Dahal K，Sharma SP，Kaur J，et al. Efficacy and Safety of Proton Pump Inhibitors in the Long-Term Aspirin Users：A Meta-Analysis of Randomized Controlled Trials [J]. Am J Ther，2017，24（5）：e559-e569.
[34] Hsiao FY，Tsai YW，Huang WF，et al. A comparison of aspirin and clopidogrel with or without proton pump inhibitors for the secondary prevention of cardiovascular events in patients at high risk for gastrointestinal bleeding [J]. Clin Ther，2009，31（9）：2038-2047.
[35] Lanas A，Rodrigo L，Marquez JL，et al. Low frequency of upper gastrointestinal complications in a cohort of high-risk patients taking low-dose aspirin or NSAIDS and omeprazole [J]. Scand J Gastroenterol，2003，38（7）：693-700.
[36] Ibanez L，Vidal X，Vendrell L，et al. Upper gastrointestinal bleeding associated with antiplatelet drugs [J]. Aliment Pharmacol Ther，2006，23（2）：235-242.
[37] Lanas A，Garcia-Rodriguez LA，Arroyo MT，et al. Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with nonsteroidal anti-inflammatory drugs，antiplatelet agents，and anticoagulants [J]. Am J Gastroenterol，2007，102（3）：507-515.
[38] Szabo IL，Matics R，Hegyi P，et al. PPIs Prevent Aspirin-Induced Gastrointestinal Bleeding Better than H2RAs. A Systematic Review and Meta-analysis [J]. J Gastrointestin Liver Dis，2017，26（4）：395-402.
[39] Mo C，Sun G，Wang YZ，et al. PPI versus Histamine H2 Receptor Antagonists for Prevention of Upper Gastrointestinal Injury Associated with Low-Dose Aspirin：Systematic Review and Meta-analysis [J]. PLoS One，2015， 10（7）：e0131558.
[40] Nakashima S，Ota S，Arai S，et al. Usefulness of anti-ulcer drugs for the prevention and treatment of peptic ulcers induced by low doses of aspirin [J]. World J Gastroenterol，2009，15（6）：727-731.