title: Comparison of prophylactic effect of UGIB and effects on platelet function between PPIs and H2RAs combined with DAPT: systematic review and meta-analysis.
abstract: OBJECTIVE
  We compared prophylactic effects of proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) on upper gastrointestinal bleeding (UGIB) associated with dual antiplatelet therapy (DAPT) and explored this influence on platelet function.
  
  
  METHODS
  Randomized controlled trials and cohort studies comparing PPIs with H2RAs in adults receiving DAPT were collected from PubMed, EMBASE and Cochrane databases. Dichotomous data were pooled to obtain risk ratios (RRs) for UGIB, major adverse cardiovascular events (MACEs), poor responders to clopidogrel and rehospitalization, and continuous data were pooled to obtain mean differences (MDs) for P2Y12reaction units (PRUs), with 95% confidence intervals (CIs).
  
  
  RESULTS
  Twelve clinical trials (n=3,301) met the inclusion criteria. Compared to H2RAs, PPIs lessened UGIB (RR =0.16, 95% CI: 0.03-0.70), and there was no significant difference in the incidence of PRUs (MD =18.21 PRUs, 95% CI: -4.11-40.54), poor responders to clopidogrel (RR =1.21, 95% CI: 0.92-1.61), incidence of MACEs (RR =0.89, 95% CI: 0.45-1.75) or rehospitalization (RR =1.76, 95% CI: 0.79-3.92). Subgroup analysis confirmed fewer PRUs in the H2RAs group compared to the omeprazole group (2 studies, n=189, MD =31.80 PRUs, 95% CI: 11.65-51.96). However, poor responder data for clopidogrel and MACEs might be unreliable because few studies of this kind were included.
  
  
  CONCLUSIONS
  Limited evidence indicates that PPIs were better than H2RAs for prophylaxis of UGIB associated with DAPT and had no effect on platelet function. Further study is needed to confirm these observations.
authors.affiliation: Department of Pharmacy, Peking University Third Hospital, Beijing.
authors.forename: Zhan-Miao
authors.initials: ZM
authors.lastname: Yi
authors.affiliation: Department of Pharmacy, Peking University Third Hospital, Beijing; Department of Pharmacy, China Pharmaceutical University, Nanjing, People's Republic of China.
authors.forename: Ting-Ting
authors.initials: TT
authors.lastname: Qiu
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Pharmacy, Peking University Third Hospital, Beijing.
authors.forename: Zhi-Yan
authors.initials: ZY
authors.lastname: Liu
authors.affiliation: Department of Pharmacy, Peking University Third Hospital, Beijing.
authors.forename: Suo-Di
authors.initials: SD
authors.lastname: Zhai
keywords: dual-antiplatelet therapy; histamine-2 receptor antagonists; meta-analysis; platelet function; proton pump inhibitors; upper gastrointestinal bleeding