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Volume 5 Journal of Pharmaceutical Care & Health Systems Pharma Middle East 2018
November 05-07, 2018
November 05-07, 2018 Abu Dhabi, UAE
18th Annual
Pharma Middle East Congress
Association between Proton Pump Inhibitors use and New Onset of Ischemic Stroke in A Tertiary
Hospital, King Abdul-Aziz Medical City-Central Region Saudi Arabia: Retrospective Study
Maha AlMolaiki1, Rami Bustami2 and Husam I Ardah3, 4, 5
1King Abdulaziz Medical City-Central Region, Saudi Arabia
2King Saud University, Saudi Arabia
3King Abdullah International Medical Research Center, Saudi Arabia
4King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia
5King Abdulaziz Medical City-Central Region, Saudi Arabia
Background: Stroke is a rapid loss of brain function due to
disruption of blood supply to the brain and a major cause of
mortality andmorbidity worldwide. In Saudi Arabia the incidence
of ischemic stroke is 69%. Risk factors are: hypertension, diabetes
mellitus, smoking, dyslipidemia. Proton pump inhibitors (PPIs)
one of the world’s most frequently prescribed medications
contributed to many adverse effects. Retrospective study found
a significant increase in risk of new onset ischemic stroke in the
PPIs users. Prospective cohort study found no association.
Aim: assess the likelihood of developing new onset ischemic
stroke among patients who were using PPIs for 6 months or more
versus patients who were not using PPIs.
Method: Case-control study at King Abdulaziz Medical City
central region, from January2016 to January2017.Sample size
calculations based on probability type I error of 0.05,80%power,
estimated to be 400[200 ischemic stroke(cases) and 200 non-
ischemic stroke(controls)]. Each group obtained by simple
random sampling, medications reviewed if patients were using
PPIs. The association between PPIs use, demographic data,
clinical factors and development of ischemic stroke evaluated
by using Odds Ratio (OR) and 95%confidence interval (CI).
Continuous data expressed as mean ±SD. Categorical data
analyzed using the Chi-square test.
Result: 128 patients met the inclusion criteria.64 patients with
47 on PPIs had new onset ischemic stroke (meanage69.14±11.57,
53.13%were male), 64 patients with 39 on PPIs without ischemic
stroke (mean age 60.88±12.49, 54.69%were female). Primary
endpoint: there was insignificant association between patients
with previous exposure to PPIs and ischemic stroke (Odds
Ratio (OR) 0.396; 95% (CI) 0.111–1.415),In comparison to the
retrospective study. For secondary endpoint: the incidence of
ischemic stroke was insignificant between patients who used
different doses, 20mg orally daily in ischemic and non-ischemic
stroke (29.79%Vs.48.72%, respectively), and 40mg orally daily
in ischemic stroke and non-ischemic stroke (70.21%Vs.51.28%,
respectively), P=0.0723.
Maha AlMolaiki, J Pharma Care Health Sys 2018, Volume 5
DOI: 10.4172/2376-0419-C4-035
Table (1) Baseline Characteristics
Characteristics Outcome p-value
Ischemic
(N=64)
Non-Isch-
emic(N=64)
Age (years) 69.14 (11.57) 60.88 (12.49) 0.0003
Gender
Male
Female
53.13%
46.88%
45.31%
54.69%
0.3767
weight 75.50(14.46) 84.54(19.32) 0.0031
Height 159.88(10.22) 160.44(9.17) 0.8338
Smoking
Yes
No
Not available
1.56%
56.25%
42.19%
3.13%
43.75%
53.13%
0.3436
Previous medical history
Hypertension
Diabetes mellitus
Dyslipidemia
Heart Failure
Myocardial Infarction
Atrial Fibrillation
Coronary Artery Disease
Chronic Kidney Disease
Peripheral Vascular
Disease
Carotid Artery Stenosis
92.19%
67.19%
68.75%
7.81%
0.00
12.50%
21.88%
9.38%
1.56%
9.38%
54.69%
67.19%
73.44%
14.06%
4.69
3.13%
20.63%
7.81%
3.13%
0.00
<0.0001
1.0000
0.5586
0.2573
0.0797
0.0481
0.8644
0.7525
0.5591
0.0121
Chronic Kidney Disease
Peripheral Vascular
Disease
Carotid Artery Stenosis
73.44%
51.56%
21.88%
60.94%
37.50%
21.88%
0.1321
0.1095
1.0000
Doses
20mg orally once daily
40mg orally once daily
29.79%
70.21%
48.72%
51.28%
0.0723
Indications
Refractory gastroesoph-
ageal
reflux disease
Non-Steroidal Anti-
inflammatory Drugs use
Other
1.56%
3.13%
3.13%
3.13%
6.25%
17.19%
0.5591
0.4030
0.0085
Table (2) Predictors risk factors of ischemic stroke.
Parameter p-value OR 95% Confidence
Interval
Proton pump inhibitors
use
Weight
Gender
Heart failure
Hypertension
0.1541
0.0380
0.1649
0.0302
<.0001
0.396
0.961
0.303
13.367
43.642
0.111-1.415
0.925-0.998
0.056-1.633
1.282-139.333
7.544-252.461