The Role of Acid Suppressants in the Prevention of Anticoagulant-Related Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis
- 주제(키워드) Anticoagulants , Acid suppressants , Gastrointestinal hemorrhage
- 주제(기타) Gastroenterology & Hepatology
- 설명문(일반) [Bang, Chang Seok] Hallym Univ, Dept Internal Med, Coll Med, Chunchon, South Korea; [Joo, Moon Kyung] Korea Univ, Dept Internal Med, Div Gastroenterol, Coll Med, Seoul, South Korea; [Kim, Byung-Wook; Kim, Joon Sung] Catholic Univ Korea, Incheon St Marys Hosp, Coll Med, Dept Internal Med, 56 Dongsu Ro, Seoul 21431, South Korea; [Park, Chan Hyuk] Hanyang Univ, Guri Hosp, Dept Internal Med, Coll Med, Guri, South Korea; [Ahn, Ji Yong; Lee, Jeong Hoon] Univ Ulsan, Asan Med Ctr, Dept Internal Med, Div Gastroenterol,Coll Med, Seoul, South Korea; [Lee, Bong Eun] Pusan Natl Univ, Pusan Natl Univ Hosp, Biomed Res Inst, Dept Internal Med,Sch Med, Busan, South Korea; [Yang, Hyo-Joon] Sungkyunkwan Univ, Dept Internal Med, Div Gastroenterol, Sch Med, Seoul, South Korea; [Yang, Hyo-Joon] Sungkyunkwan Univ, Dept Internal Med, Gastrointestinal Canc Ctr, Kangbuk Samsung Hosp, Seoul, South Korea; [Cho, Yu Kyung; Park, Jae Myung] Catholic Univ Korea, Seoul St Marys Hosp, Coll Med, Dept Internal Med, Seoul, South Korea; [Kim, Beom Jin] Chung Ang Univ, Chung Ang Univ Hosp, Dept Internal Med, Coll Med, Seoul, South Korea; [Jung, Hye-Kyung] Ewha Womans Univ, Ewha Med Res Inst, Dept Internal Med, Sch Med, Seoul, South Korea
- 등재 SCIE, SCOPUS, KCI등재
- OA유형 Green Submitted, gold, Green Published
- 발행기관 EDITORIAL OFFICE GUT & LIVER
- 발행년도 2020
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000166107
- 본문언어 영어
- Published As http://dx.doi.org/10.5009/gnl19009
- PubMed https://pubmed.ncbi.nlm.nih.gov/30974930
초록/요약
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.
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