Association of Proton Pump Inhibitor Prophylaxis on Clinical Outcome in Acute Ischemic Stroke in China: A Multicenter Retrospective Cohort Study
Background: Overtreatment with proton pump inhibitors (PPIs) in acute ischemic stroke (AIS) patients continues to grow. We aimed to investigate the frequency of PPI prophylaxis without an appropriate indication in AIS patients in China and clarify the association between PPI prophylaxis and long-ter...
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MDPI AG
2022-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/23/6881 |
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| author | Lei Fang Wansi Zhong Xiaoxian Gong Zhicai Chen Yi Chen Shenqiang Yan Min Lou |
| author_facet | Lei Fang Wansi Zhong Xiaoxian Gong Zhicai Chen Yi Chen Shenqiang Yan Min Lou |
| author_sort | Lei Fang |
| collection | DOAJ |
| description | Background: Overtreatment with proton pump inhibitors (PPIs) in acute ischemic stroke (AIS) patients continues to grow. We aimed to investigate the frequency of PPI prophylaxis without an appropriate indication in AIS patients in China and clarify the association between PPI prophylaxis and long-term prognosis. Methods: Based on a multicenter stroke registry database, neurological outcomes, stroke events, recurrent ischemic strokes, and all-cause death were compared between patients with and without PPI prophylaxis. Results: A total of 4542 AIS were included, and 3335 (73.4%) received PPI prophylaxis. Patients with PPI prophylaxis were more likely to have a poor outcome at 1 year than those without PPI prophylaxis (33.3% vs. 25.8%, OR 1.321; 95% CI 1.102–1.584; <i>p</i> = 0.003). No significant differences were found in all-cause death, stroke event, or recurrent ischemic stroke at 1 year between the two groups. After propensity score matching, PPI prophylaxis was still independently associated with a higher rate of poor outcome (30.9% vs. 25.8%, OR 1.432; 95% CI 1.151–1.780; <i>p</i> = 0.001). Sensitivity analysis also showed that PPI prophylaxis increased the rate of a poor outcome in minor strokes or at different durations of PPI prophylaxis. Conclusions: Approximately 3/4 of AIS patients were given PPI prophylaxis during hospitalization, which was associated with a poor long-term outcome. |
| first_indexed | 2024-03-09T17:44:13Z |
| format | Article |
| id | doaj.art-1c8b145dc19d4c89af7110cf11257849 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T17:44:13Z |
| publishDate | 2022-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-1c8b145dc19d4c89af7110cf112578492023-11-24T11:19:16ZengMDPI AGJournal of Clinical Medicine2077-03832022-11-011123688110.3390/jcm11236881Association of Proton Pump Inhibitor Prophylaxis on Clinical Outcome in Acute Ischemic Stroke in China: A Multicenter Retrospective Cohort StudyLei Fang0Wansi Zhong1Xiaoxian Gong2Zhicai Chen3Yi Chen4Shenqiang Yan5Min Lou6Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, ChinaDepartment of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, ChinaDepartment of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, ChinaDepartment of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, ChinaDepartment of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, ChinaDepartment of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, ChinaDepartment of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, ChinaBackground: Overtreatment with proton pump inhibitors (PPIs) in acute ischemic stroke (AIS) patients continues to grow. We aimed to investigate the frequency of PPI prophylaxis without an appropriate indication in AIS patients in China and clarify the association between PPI prophylaxis and long-term prognosis. Methods: Based on a multicenter stroke registry database, neurological outcomes, stroke events, recurrent ischemic strokes, and all-cause death were compared between patients with and without PPI prophylaxis. Results: A total of 4542 AIS were included, and 3335 (73.4%) received PPI prophylaxis. Patients with PPI prophylaxis were more likely to have a poor outcome at 1 year than those without PPI prophylaxis (33.3% vs. 25.8%, OR 1.321; 95% CI 1.102–1.584; <i>p</i> = 0.003). No significant differences were found in all-cause death, stroke event, or recurrent ischemic stroke at 1 year between the two groups. After propensity score matching, PPI prophylaxis was still independently associated with a higher rate of poor outcome (30.9% vs. 25.8%, OR 1.432; 95% CI 1.151–1.780; <i>p</i> = 0.001). Sensitivity analysis also showed that PPI prophylaxis increased the rate of a poor outcome in minor strokes or at different durations of PPI prophylaxis. Conclusions: Approximately 3/4 of AIS patients were given PPI prophylaxis during hospitalization, which was associated with a poor long-term outcome.https://www.mdpi.com/2077-0383/11/23/6881acute ischemic strokegastrointestinal bleedsproton pump inhibitor prophylaxisoutcome |
| spellingShingle | Lei Fang Wansi Zhong Xiaoxian Gong Zhicai Chen Yi Chen Shenqiang Yan Min Lou Association of Proton Pump Inhibitor Prophylaxis on Clinical Outcome in Acute Ischemic Stroke in China: A Multicenter Retrospective Cohort Study Journal of Clinical Medicine acute ischemic stroke gastrointestinal bleeds proton pump inhibitor prophylaxis outcome |
| title | Association of Proton Pump Inhibitor Prophylaxis on Clinical Outcome in Acute Ischemic Stroke in China: A Multicenter Retrospective Cohort Study |
| title_full | Association of Proton Pump Inhibitor Prophylaxis on Clinical Outcome in Acute Ischemic Stroke in China: A Multicenter Retrospective Cohort Study |
| title_fullStr | Association of Proton Pump Inhibitor Prophylaxis on Clinical Outcome in Acute Ischemic Stroke in China: A Multicenter Retrospective Cohort Study |
| title_full_unstemmed | Association of Proton Pump Inhibitor Prophylaxis on Clinical Outcome in Acute Ischemic Stroke in China: A Multicenter Retrospective Cohort Study |
| title_short | Association of Proton Pump Inhibitor Prophylaxis on Clinical Outcome in Acute Ischemic Stroke in China: A Multicenter Retrospective Cohort Study |
| title_sort | association of proton pump inhibitor prophylaxis on clinical outcome in acute ischemic stroke in china a multicenter retrospective cohort study |
| topic | acute ischemic stroke gastrointestinal bleeds proton pump inhibitor prophylaxis outcome |
| url | https://www.mdpi.com/2077-0383/11/23/6881 |
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