The Impact of Proton Pump Inhibitors on the Efficacy of Dual Antiplatelet Therapy in Patients Following Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis
Abstract
To investigate the effects of proton pump inhibitors (PPIs) on the efficacy of dual antiplatelet therapy (DAPT) in patients following percutaneous coronary intervention (PCI). A computer-based search was conducted in the Cochrane Library, ClinicalTrials.gov, and PubMed databases up to September 30, 2024. Randomized controlled trials (RCTs) evaluating the application of DAPT in conjunction with PPIs in post-PCI patients were included. This network meta-analysis included a total of 6 RCTs with 2,826 participants. The direct meta-analysis of the incidence of major adverse cardiovascular events (MACE) yielded a combined effect size of OR 0.87 (95% CI: 0.71, 1.06). Subgroup analyses by PPI type revealed an OR of 0.85 (95% CI: 0.70, 1.05) for pantoprazole, 0.49 (95% CI: 0.04, 5.59) for lansoprazole, and 1.83 (95% CI: 0.51, 6.53) for omeprazole. For gastrointestinal event incidence, the direct meta-analysis resulted in a combined effect size of OR 0.22 (95% CI: 0.10, 0.46). The ORs for pantoprazole, lansoprazole, and omeprazole were 0.23 (95% CI: 0.07, 0.70), 0.18 (95% CI: 0.02, 1.62), and 0.13 (95% CI: 0.02, 0.73), respectively. The network meta-analysis indicated that the preferred hierarchy for reducing MACE risk is lansoprazole, followed by pantoprazole and omeprazole. In contrast, for minimizing gastrointestinal event risk, the preferred order was omeprazole, followed by lansoprazole and pantoprazole. For patients after PCI, the combination of DAPT and PPIs is recommended to…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 2,826 participants or records.
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