Gastroenterology:泮托拉唑可预防接受利伐沙班和/或阿司匹林患者的胃十二指肠事件

2020-07-02 MedSci原创 MedSci原创

抗血小板和抗凝剂与上消化道出血增加有关。本研究中,我们评估了质子泵抑制剂治疗是否可以降低这种风险。

抗血小板和抗凝剂与上消化道出血增加有关。本研究中,我们评估了质子泵抑制剂治疗是否可以降低这种风险。

 

我们对17,598名患有稳定血管疾病和外周动脉疾病的参与者进行了3×2部分因子双盲试验。参与者被随机分配到每天给予泮托拉唑40mg或安慰剂,以及利伐沙班2.5mg每天两次与阿司匹林100mg每天一次,利伐沙班5mg每天两次,或单独给予阿司匹林100mg的组。主要结果是首次上消化道事件发生时间,定义为出血、胃十二指肠病变或不明原因的上消化道出血、隐性出血、症状性胃十二指肠溃疡或≥5个糜烂、上消化道梗阻或穿孔的复合。

 

结果显示,泮托拉唑组(8791个事件中的102个)和安慰剂组(8807个事件中的116个)之间的上消化道事件没有显著差异(危险比,0.88;95%置信区间[CI],0.67-1.15)。泮托拉唑显著减少了胃十二指肠病变的出血(危险比,0.52;95%置信区间,0.28-0.94;P = .03);当我们使用事后定义的胃十二指肠病变出血时,这种减少更大(危险比,0.45;95%置信区间,0.27-0.74),尽管需要治疗的人数仍然很高(n = 982;95%置信区间,609-2528)。

 

综上所述,该研究结果表明,在接受低剂量抗凝和/或阿司匹林治疗的稳定心血管疾病患者中常规使用质子泵抑制剂并不能减少上消化道事件,但可以减少胃十二指肠病变出血。

 

原始出处:

 

Paul MoayyediJohn W Eikelboom, et al., Pantoprazole to Prevent Gastroduodenal Events in Patients Receiving Rivaroxaban and/or Aspirin in a Randomized, Double-Blind, Placebo-Controlled Trial. Gastroenterology. 2019 Aug;157(2):403-412.e5. doi: 10.1053/j.gastro.2019.04.041. 

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    2020-12-12 许安
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