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<p>Current evidence of whether proton pump inhibitor (PPI) reduces the risk of gastrointestinal bleeding (GIB) associated with oral anticoagulants (OACs) is limited. Propensity score-weighted cohort and case-crossover studies were conducted separately in England and Hong Kong between 2011.01.01 and 2019.12.31. In the cohort design, we compared the hazards of hospitalised GIB in <Emphasis Type="BoldItalic">OAC</Emphasis> + <Emphasis Type="BoldItalic">PPI</Emphasis> users with <Emphasis Type="BoldItalic">OAC only</Emphasis> users in people with atrial fibrillation and found higher hazard of GIB in <Emphasis Type="BoldItalic">OAC</Emphasis> + <Emphasis Type="BoldItalic">PPI</Emphasis> users in both settings. In the case-crossover design, elevated odds of exposure to <Emphasis Type="BoldItalic">PPI only</Emphasis>, <Emphasis Type="BoldItalic">OAC only</Emphasis> and <Emphasis Type="BoldItalic">OAC</Emphasis> + <Emphasis Type="BoldItalic">PPI</Emphasis> associated with GIB between 30-day hazard and referent periods were similarly found in both settings. Overall, the evidence of an elevated risk of <Emphasis Type="BoldItalic">OAC</Emphasis> + <Emphasis Type="BoldItalic">PPI</Emphasis> associated with GIB compared with <Emphasis Type="BoldItalic">OAC only</Emphasis> was modest in the cohort study. Our case-crossover study suggested that residual confounding is likely to explain the association, suggesting that concomitant prescription of PPI with OAC did not modify GIB.</p>

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The association between proton pump inhibitors and the risk of gastrointestinal bleeding in oral anticoagulants users

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月12日

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  • Zixuan Wang,
  • Qiuyan Yu,
  • Charlotte Warren-Gash,
  • Krishnan Bhaskaran,
  • Clémence Leyrat,
  • Ka Shing Cheung,
  • Celine S. L. Chui,
  • Esther W. Chan,
  • Ian C. K. Wong,
  • Amitava Banerjee,
  • Liam Smeeth,
  • Ian J. Douglas,
  • Angel Y. S. Wong

摘要

Current evidence of whether proton pump inhibitor (PPI) reduces the risk of gastrointestinal bleeding (GIB) associated with oral anticoagulants (OACs) is limited. Propensity score-weighted cohort and case-crossover studies were conducted separately in England and Hong Kong between 2011.01.01 and 2019.12.31. In the cohort design, we compared the hazards of hospitalised GIB in OAC + PPI users with OAC only users in people with atrial fibrillation and found higher hazard of GIB in OAC + PPI users in both settings. In the case-crossover design, elevated odds of exposure to PPI only, OAC only and OAC + PPI associated with GIB between 30-day hazard and referent periods were similarly found in both settings. Overall, the evidence of an elevated risk of OAC + PPI associated with GIB compared with OAC only was modest in the cohort study. Our case-crossover study suggested that residual confounding is likely to explain the association, suggesting that concomitant prescription of PPI with OAC did not modify GIB.