Sixty-three RCTs (n=7,218) were included.
The mean overall score for methodology was 5.3.
Overt bleeding: histamine-H2-receptor antagonists significantly reduced overt bleeding in comparison to both placebo or no therapy, OR 0.58 (95% CI: 0.42, 0.79) (trials were shown to be statistically heterogeneous), and antacid therapy, OR 0.44 (95% CI: 0.37, 0.84). Sucralfate significantly decreased overt bleeding in comparison to no prophylaxis, OR 0.58 (95% CI: 0.34, 0.99). A strong trend in favour of antacids over placebo or no therapy was demonstrated, but not found to be statistically significant. There was no evidence to suggest a differential effectiveness of sucralfate versus either antacids or histamine-H2-receptor antagonists for overt bleeding.
Clinically-important bleeding: histamine-H2-receptor antagonists were shown to be statistically-significantly superior to placebo or no therapy, OR 0.44 (95% CI: 0.22, 0.88). No other statistically-significant differences were demonstrated, although there was a trend in favour of histamine-H2-receptor antagonists versus antacids in the prevention of clinically-important bleeding.
Pneumonia: a trend toward a lower incidence of pneumonia was demonstrated when sucralfate was compared to either antacid therapy or histamine-H2-receptor antagonists. Histamine-H2-receptor antagonists were associated with an increased incidence of pneumonia in comparison with no prophylaxis. This difference was not statistically significant.
Mortality: sucralfate was associated with a statistically-significant reduction in mortality when compared to antacids, OR 0.73 (95% CI: 0.54, 0.97). A trend in favour of sucralfate over histamine-H2-receptor antagonists was also demonstrated.