The Efficacy and Safty of Proton Pump Inhibitor (Lansoprazole) (PPI)

The Efficacy and Safety of Proton Pump Inhibitor ( in Patients With Moderate Bleeding Risk and Coronary Artery Disease Undergoing Percutaneous Coronary: A Randomised, Open ,Compared With Control

Among patients who performed percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD), enrollment is performed in patients with moderate risk in gastrointestinal risk assessment indicators. After obtaining the consent form, patients are randomly assigned to the gastric acid secretion inhibitor group and the non-dose group. Researchers and subjects proceed with the treatment group assignment, treatment-group assignment uses a random number table and the assigned drug is disclosed. Random checks are generated by statisticians and managed by the researchers. In the test group, the incidence of gastrointestinal clinical events in DAPT patients is expected to be low while taking PPI, but there is a burden of PPI costs. In the case of the control group, the burden of PPI costs is reduced, but there is a possibility that the incidence of clinical events may occur, although it is a small number. Subjects in the test group will take DAPT for at least 6 months from the time of registration, and NSAIDs drugs or steroids and NOAC or warfarin should be prohibited as combination taboo drugs when participating in the study. Data will be collected during normal medical procedures and will be checked through an endoscope in case of upper gastrointestinal bleeding

Purpose : This study compares gastrointestinal and cardiovascular events with coronary artery disease (CAD) patients who underwent percutaneous coronary angioplasty in patients with moderate gastrointestinal bleeding risk with use of dual antiplatelet drugs (DAPT), especially controversial use of prophylactic acid secretion inhibitors, and attempts to confirm the effectiveness and safety of gastric acid secretion inhibitors Background : DPAT is a standard treatment in patients with CAD with percutaneous coronary intervention (PCI). However, it is important to consider the GI bleeding risk when using DAPT and to determine whether Proton Pump Inhibitor (PPI) should be prescribed to prevent such accidents. DAPT, or aspirin and P2Y12 receptor inhibitor, complementarily reduce platelet activation and aggregation and consequently reduce the progression of coronary thrombosis. We have reported whether PPI use is associated with ischemic events or mortality in patients with DAPT up to date, but we have shown conflicting results depending on the type of study conducted. Observational studies generally show that PPI increases all-cause and cardiovascular mortality, angina and stroke, while RCT studies show that it does not. This difference can be explained by the selection bias. This is because observational studies attempt to reduce selective bias through correction of basic patient characteristics, but unmeasured differences in underlying variables continue to affect the results. method : Among patients who performed PCI in patients with CAD, enrollment is performed in patients with moderate risk in gastrointestinal risk assessment indicators. After obtaining the consent form, patients are randomly assigned to the gastric acid secretion inhibitor group and the non-dose group. Researchers and subjects proceed with the treatment group assignment, treatment-group assignment uses a random number table and the assigned drug is disclosed. Random checks are generated by statisticians and managed by the researchers. In the test group, the incidence of gastrointestinal clinical events in DAPT patients is expected to be low while taking PPI, but there is a burden of PPI costs. In the case of the control group, the burden of PPI costs is reduced, but there is a possibility that the incidence of clinical events may occur, although it is a small number. Subjects in the test group will take DAPT for at least 6 months from the time of registration, and NSAIDs drugs or steroids and NOAC or warfarin should be prohibited as combination taboo drugs when participating in the study. Data will be collected during normal medical procedures and will be checked through an endoscope in case of upper gastrointestinal bleeding

proton pump inhibitor, percutaneous coronary intervention, gastrointestinal bleeding of moderate risk, dual anti-platelet drugs

Short-term treatment of active duodenal ulcer Short-term treatment of active benign gastric ulcers Thin heat of Helicobacter pylori to prevent recurrence of duodenal ulcer Maintain duodenal ulcer after treatmentLaw Treatment of nonsteroidal anti-inflammatory analgesics-induced gastric ulcers Reducing the risk of developing nonsteroidal anti-inflammatory analgesic-induced gastric ulcers Short-term treatment of gastroesophageal reflux disease Short-term treatment of erosive reflux esophagitis Post-treatment maintenance therapy for erosive reflux esophagitis Pathological hyperdivision, including Zolinger Ellison syndrome

Upper gastrointestinal bleeding with clear origin,upper gastrointestinal bleeding with unclear origin, potential upper gastrointestinal bleeding or perforation

Combined variables of cardiovascular death, non-fatal myocardial infarction, coronary artery reopening, or ischemic stroke

Inclusion Criteria: 19 years of age or older Coronary artery disease has one or more of the following Stable angina unstable angina N on ST elevation myocardial infarction ST elevation myocardial infarction Those who are scheduled to receive or are taking dual antiplatelet therapy including aspirin after PCI trials A person whose risk of bleeding falls under an intermediate risk group. Exclusion Criteria: age < 19 years known allergy to aspirin and clopidogrel A person classified as a high-risk group according to the gastrointestinal risk assessment index liver cirrhosis known iron deficiency anemia recent fibrinolytic therapy active cancer end-stage renal failure life expectancy < 1 year co-prescription of NSAIDs, corticosteroid and anticoagulant such as NOAC or warfarin pregnancy mentally or cognitively disabled people mechanical ventilation with endotracheal intubation Persons who do not agree to participate in the study persons related unequally to investigators (students and employees)

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ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID

Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation

Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation

Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009

Reduced risk of gastrointestinal bleeding associated with proton pump inhibitor therapy in patients treated with dual antiplatelet therapy after myocardial infarction

Safety of Proton Pump Inhibitors Based on a Large, Multi-Year, Randomized Trial of Patients Receiving Rivaroxaban or Aspirin

2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European