Response by Malhotra et al to the Letters Regarding Article, “Cerebrovascular Outcomes With Proton Pump Inhibitors and Thienopyridines: A Systematic Review and Meta-Analysis”
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
We would like to thank Dr Guijarro for reading and commenting on our recently published systematic review and meta-analysis on the cerebrovascular outcomes of patients receiving concomitant treatment with proton pump inhibitors (PPI) and thienopyridines.1 Although we understand the concern raised by Dr Guijarro that the 2 included randomized-controlled clinical trials (RCTs)2,3 did not report significant interactions of PPI and thienopyridines coadministration with cerebrovascular outcomes, it should be taken into consideration that these trials were not designed to assess the impact of the aforementioned drug interaction on cerebrovascular outcomes as a primary outcome and thus might have been both underpowered regarding this specific end point.2,3 The concern raised by Dr Guijarro regarding the nonrandom allocation of PPI administration in the majority of included post-hoc analyses of RCTs has been highlighted with high-risk allocation in 3 domains of bias assessment (selection bias, reporting bias, and other bias) using the Cochrane risk of bias tool (Table III in …