SynthesisCirculation. Cardiovascular quality and outcomes2015
Conflicting results between randomized trials and observational studies on the impact of proton pump inhibitors on cardiovascular events when coadministered with dual antiplatelet therapy: systematic review.
Synthesis in Circulation. Cardiovascular quality and outcomes, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 49 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
49 citing papers in PubMed, 5 syntheses or guidelines pooled it, 121 citations in OpenAlex.
- Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials: a meta-epidemiological study.The Cochrane database of systematic reviews · 2024Pooled it
- The Efficacy and Safety of Proton Pump Inhibitors Combining Dual Antiplatelet Therapy in Patients with Coronary Intervention: A Systematic Review, Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials.Reviews in cardiovascular medicine · 2023Pooled it
- Efficacy and safety of concomitant use of proton pump inhibitors with aspirin-clopidogrel dual antiplatelet therapy in coronary heart disease: A systematic review and meta-analysis.Frontiers in pharmacology · 2022Pooled it
- Meta-Analysis of Efficacy and Safety of Proton Pump Inhibitors with Dual Antiplatelet Therapy for Coronary Artery Disease.Cardiovascular revascularization medicine : including molecular interventions · 2019Pooled it
- Individual Proton Pump Inhibitors and Outcomes in Patients With Coronary Artery Disease on Dual Antiplatelet Therapy: A Systematic Review.Journal of the American Heart Association · 2015Pooled it
- Impact of CYP2C19 and CYP3A4 Inhibitor Use on Clopidogrel Clinical Effectiveness in CYP2C19 Genotyped Patients Undergoing Percutaneous Coronary Intervention.Clinical pharmacology and therapeutics · 2026Observational
- Comparison of Cardiovascular Events in Patients Receiving Concomitant Clopidogrel and Proton Pump Inhibitors Classified by CYP2C19 Inhibitory Potency.Arteriosclerosis, thrombosis, and vascular biology · 2026Observational
- Effect of Acupuncture on Pneumonia Risk in Stroke Patients using Proton Pump Inhibitors: A Retrospective Case-Control Study.Brain and behavior · 2025Article
- Risk of Ischaemic Stroke Varies With Antithrombotic Drugs Use in Proton Pump Inhibitor Users: A Self-Controlled Case Series Study.Pharmacoepidemiology and drug safety · 2025Article
- Risk Factors for Upper Gastrointestinal Bleeding in Patients Undergoing Percutaneous Coronary Intervention on Dual Antiplatelet Therapy with Assessment of Anti-Ulcer Medication Effects.Acta Cardiologica Sinica · 2025Article
- Potential Risks Associated With Long-term Use of Proton Pump Inhibitors and the Maintenance Treatment Modality for Patients With Mild Gastroesophageal Reflux Disease.Journal of neurogastroenterology and motility · 2024Review
- Impact of proton pump inhibitor use on clinical outcomes in East Asian patients receiving clopidogrel following drug-eluting stent implantation.BMC medicine · 2024Article
- Antacid Therapy in Coronary Artery Disease and Heart Failure: Proton Pump Inhibitors vs. HCardiovascular drugs and therapy · 2024Review
- GERD: Latest update on acid-suppressant drugs.Current research in pharmacology and drug discovery · 2024Article
- Assessing the use of observational methods and real-world data to emulate ongoing randomized controlled trials.Clinical trials (London, England) · 2023Article
- Immune checkpoint inhibitors and their interaction with proton pump inhibitors-related interstitial nephritis.Clinical kidney journal · 2023Review
- Review
- The Safety of Long-Term Proton Pump Inhibitor Use on Cardiovascular Health: A Meta-Analysis.Journal of clinical medicine · 2022Review
- Gastroesophageal Reflux in Children with Asthma.Children (Basel, Switzerland) · 2022Article
- Comparative effectiveness and safety of pharmaceuticals assessed in observational studies compared with randomized controlled trials.BMC medicine · 2021Review
Corrections and comments
- Commented on by
- Erratum issuedCorrection.2016
Authors and funding
8 authors at 1 institution in 1 country.
Funding
Abstract
backgroundDiscordant results have been reported on the effects of concomitant use of proton pump inhibitors (PPIs) and dual antiplatelet therapy (DAPT) for cardiovascular outcomes. We conducted a systematic review comparing the effectiveness and safety of concomitant use of PPIs and DAPT in the postdischarge treatment of unstable angina/non-ST-segment-elevation myocardial infarction patients. METHODS AND
resultsWe searched for clinical studies in MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews, from 1995 to 2012. Reviewers screened and extracted data, assessed applicability and quality, and graded the strength of evidence. We performed meta-analyses of direct comparisons when outcomes and follow-up periods were comparable. Thirty-five studies were eligible. Five (4 randomized controlled trials and 1 observational) assessed the effect of omeprazole when added to DAPT; the other 30 (observational) assessed the effect of PPIs as a class when compared with no PPIs. Random-effects meta-analyses of the studies assessing PPIs as a class consistently reported higher event rates in patients receiving PPIs for various clinical outcomes at 1 year (composite ischemic end points, all-cause mortality, nonfatal MI, stroke, revascularization, and stent thrombosis). However, the results from randomized controlled trials evaluating omeprazole compared with placebo showed no difference in ischemic outcomes, despite a reduction in upper gastrointestinal bleeding with omeprazole.
conclusionsLarge, well-conducted observational studies of PPIs and randomized controlled trials of omeprazole seem to provide conflicting results for the effect of PPIs on cardiovascular outcomes when coadministered with DAPT. Prospective trials that directly compare pharmacodynamic parameters and clinical events among specific PPI agents in patients with unstable angina/non-ST-segment-elevation myocardial infarction treated with DAPT are warranted.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.