Prevention of nNon-Vitamin K Oral Anticoagulants-Related Gastrointestinal Bleeding With Acid Suppressants: A Systematic Review and Meta-Analysis

Dong, Yongqi; He, Song; Li, Xue; Zhou, Zhihang

doi:10.1177/10760296211064897

Cited by 6 publications

(6 citation statements)

References 46 publications

(66 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although our study reports a reduced risk of gastrointestinal bleeding associated with PPI use in VKA initiators [ 17 , 18 , 43 , 44 ], it did not confirm the risk reduction observed in previous studies among DOAC initiators [ 16 – 18 , 43 , 45 ]. This result is surprising, as the meta-analysis by Anh et al reported little difference in the risk of UGIB according to the type of OAC; OR = 0.65 (95% CI 0.62–0.69) for warfarin, OR = 0.67 (95% CI 0.56–0.81) for apixaban, OR = 0.56 (95% CI 0.45–0.69) for dabigatran, and OR = 0.76 (95% CI 0.62–0.91) for rivaroxaban [ 43 ].…”

Section: Discussioncontrasting

confidence: 99%

Do Proton Pump Inhibitors Reduce Upper Gastrointestinal Bleeding in Older Patients with Atrial Fibrillation Treated with Oral Anticoagulants? A Nationwide Cohort Study in France

Drusch,

Neumann,

Michelon

et al. 2023

Drugs Aging

View full text Add to dashboard Cite

Background Proton pump inhibitors (PPIs) are largely used in older adults and data are needed in off-label indications, such as the prevention of upper gastrointestinal bleeding (UGIB) in patients receiving oral anticoagulants (OACs). This study aimed to assess whether PPIs reduce the risk of UGIB in patients initiating oral anticoagulation. Methods We conducted a longitudinal study based on the French national health database. The study population included 109,693 patients aged 75–110 years with a diagnosis of atrial fibrillation who initiated OACs [vitamin K antagonist (VKA) or direct OAC (DOAC)] between 2012 and 2016. We used multivariable Cox models weighted by inverse of probability of treatment to estimate the adjusted hazard ratio (aHR) of UGIB between PPI users and nonusers over a 6- and 12-month follow-up. Results PPI users represented 23% of the study population (28% among VKA initiators and 17% among DOAC initiators). The mean age (83 ± 5.3 years) and proportion of women (near 60%) were similar between groups. The risk of UGIB in the first 6 months after initiation of OAC decreased by 20% in PPI users compared with PPI nonusers [aHR 6 months = 0.80, 95% confidence interval (CI) 0.65–0.98], but was not significantly modified when the follow-up was extended to 12 months (aHR 12 months = 0.90, 95% CI 0.76–1.07), with a stronger effect among patients treated with vitamin K antagonists (aHR 6 months = 0.73, 95% CI 0.58–0.93; aHR 12 months = 0.81, 95% CI 0.67–0.99). Conclusions This study suggests that PPIs were associated with reduced risk of gastrointestinal bleeding after initiation of oral anticoagulation in older patients with atrial fibrillation, particularly within 6 months after initiation of an antivitamin K antagonist. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-023-01085-7.

show abstract

Section: Discussioncontrasting

confidence: 99%

Do Proton Pump Inhibitors Reduce Upper Gastrointestinal Bleeding in Older Patients with Atrial Fibrillation Treated with Oral Anticoagulants? A Nationwide Cohort Study in France

Drusch,

Neumann,

Michelon

et al. 2023

Drugs Aging

View full text Add to dashboard Cite

show abstract

“…2,3 In addition, the risk of GIB was not different between new DOAC and new warfarin users in older and both sexes cohorts. As demonstrated in a systematic review and meta-analysis, which showed a reduced risk of GIB associated with DOAC by combined use of acid suppressants, 9 the combined use of acid suppressants may reduce the risk of GIB in DOAC users in realworld practice. Our data showed that 58.9% of warfarin users and 62.2% of DOAC users were prescribed "drugs for acid-related disorders" before cohort entry.…”

Section: Discussionmentioning

confidence: 94%

“…8 A systematic review and meta-analysis also reported that acid suppressants significantly reduced the risk of GIB in DOAC users, with an overall relative risk of 0.70 (95% CI, 0.61 to 0.82). 9 Therefore, the risk of GIB associated with DOAC use in real-world practice may be lower than those initially reported.…”

Section: Introductionmentioning

confidence: 86%

Real-World Risk of Gastrointestinal Bleeding for Direct Oral Anticoagulants and Warfarin Users: A Distributed Network Analysis Using a Common Data Model

Cha,

Kim,

et al. 2024

Gut and Liver

View full text Add to dashboard Cite

Background/Aims: Early studies on direct oral anticoagulants (DOACs) reported a higher risk of gastrointestinal bleeding (GIB) compared with warfarin; however, recent studies have reported a reduced risk. Therefore, this study was designed to evaluate the risk of GIB in users of DOAC and warfarin. Methods:Using a common data model, we investigated the comparative risk of GIB in subjects from eight hospitals who were newly prescribed DOACs or warfarin. We excluded subjects who had a prior history of GIB or had been prescribed both medications. After propensity score matching, we analyzed 3,347 matched pairs of new DOAC and new warfarin users. Results:The risk of GIB in new DOAC users was comparable to that in new warfarin users (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.65 to 1.40; p=0.808). New DOAC users had a similar risk of GIB to new warfarin users among older patients >65 years (HR, 1.00; 95% CI, 0.69 to 1.52; p=0.997) and in older patients >75 years (HR, 1.21; 95% CI, 0.68 to 2.10; p=0.509). In addition, the risk of GIB was not significantly different between two groups according to sex. We also found that the risk of GIB in DOAC users was 26% lower in edoxaban or apixaban subgroups compared to rivaroxaban or dabigatran subgroups (HR, 0.74; 95% CI, 0.69 to 1.00; p=0.049). Conclusions:In real-world practice, the risk of GIB in new DOAC users is comparable to that in new warfarin users. In DOAC users, the risk of GIB was lower in edoxaban or apixaban subgroups than rivaroxaban or dabigatran subgroups.

show abstract

“…The risk of GIB was reduced by the combined use of acid suppressants in anticoagulant users. 20 In a meta-analysis of five observational studies, the use of proton pump inhibitors also reduced the risk of GIB in anticoagulant users, with a common relative risk of 0.67 (95% CI, 0.61 to 0.74). 21 In a real-world practice, therefore, anticoagulant or NSAIDs are often prescribed along with acid suppressants to reduce the risk of GIB.…”

Section: Discussionmentioning

confidence: 99%

Real-World Bleeding Risk of Anticoagulant and Nonsteroidal Anti-inflammatory Drugs Combotherapy versus Anticoagulant Monotherapy

Lee,

Cha

2024

Gut and Liver

View full text Add to dashboard Cite

Background/Aims: The incidence of acute gastrointestinal bleeding (GIB) increases with the utilization of anticoagulant and nonsteroidal anti-inflammatory drugs (NSAIDs). This study aimed to compare the risk of GIB between anticoagulant and NSAIDs combotherapy and anticoagulant monotherapy in real-world practice. Methods:We investigated the relative risk of GIB in individuals newly prescribed anticoagulant and NSAIDs combination therapy and that in individuals newly prescribed anticoagulant monotherapy at three hospitals using "common data model." Cox proportional hazard models and Kaplan-Meier estimation were employed for risk comparison after propensity score matching.Results: A comprehensive analysis of 2,951 matched pairs showed that patients who received anticoagulant and NSAIDs combousers exhibited a significantly higher risk of GIB than those who received anticoagulant monousers (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.30 to 2.12; p<0.001). The risk of GIB associated with anticoagulant and NSAIDs combination therapy was also significantly higher than that associated with anticoagulant monotherapy in patients aged >65 years (HR, 1.53; 95% CI, 1.15 to 2.03; p=0.003) and >75 years (HR, 1.89; 95% CI, 1.23 to 2.90; p=0.003). We also found that the risk of GIB was significantly higher in the patients who received anticoagulant and NSAIDs combousers than that in patients who received anticoagulant monousers in both male (p=0.016) and female cohorts (p=0.010). Conclusions:The risk of GIB is significantly higher in patients who receive anticoagulant and NSAIDs combotherapy than that in patients who receive anticoagulant monotherapy. In addition, the risk of GIB associated with anticoagulant and NSAIDs combotherapy was much higher in individuals aged >75 years. Therefore, physicians should be more aware of pay more attention to the risk of GIB when they prescribe anticoagulant and NSAIDs.

show abstract

Prevention of nNon-Vitamin K Oral Anticoagulants-Related Gastrointestinal Bleeding With Acid Suppressants: A Systematic Review and Meta-Analysis

Cited by 6 publications

References 46 publications

Do Proton Pump Inhibitors Reduce Upper Gastrointestinal Bleeding in Older Patients with Atrial Fibrillation Treated with Oral Anticoagulants? A Nationwide Cohort Study in France

Do Proton Pump Inhibitors Reduce Upper Gastrointestinal Bleeding in Older Patients with Atrial Fibrillation Treated with Oral Anticoagulants? A Nationwide Cohort Study in France

Real-World Risk of Gastrointestinal Bleeding for Direct Oral Anticoagulants and Warfarin Users: A Distributed Network Analysis Using a Common Data Model

Real-World Bleeding Risk of Anticoagulant and Nonsteroidal Anti-inflammatory Drugs Combotherapy versus Anticoagulant Monotherapy

Contact Info

Product

Resources

About