Oral anticoagulant and PPI cotherapy cuts upper GI bleed risk
Background: PPIs reduce gastric acid production, promote ulcer healing, and prevent ulcer recurrence; however, limited evidence is available describing the incidence of anticoagulant-related serious upper GI tract bleeding from the newer non–vitamin K anticoagulants and PPI cotherapy.
Study design: Retrospective cohort.
Setting: Medicare enrollees.
Synopsis: With use of computerized Medicare beneficiaries files, researchers identified 1,643,123 patients with 1,713,183 new episodes of oral anticoagulant treatment between Jan. 1, 2011, and Sept. 30, 2015. This analysis showed that cotherapy with PPIs was associated with a lower incidence of upper GI bleed, with the largest difference associated with dabigatran with an incidence rate ratio of 0.49 (95% CI, 0.52-0.85), followed by warfarin (IRR, 0.65; 95%CI, 0.62-0.69), apixaban (IRR, 0.66; 95% CI, 0.52-0.85), and rivaroxaban (IRR, 0.75; 95% CI, 0.68-0.84).
Generalizability was limited by population (Medicare enrollees) and the study excluded prior hospitalizations for GI bleed, as well as switches in anticoagulant therapy during the study period.
Bottom line: PPI cotherapy with oral anticoagulation reduces risk of hospitalization for upper GI bleed.
Citation: Ray WA et al. Association of oral anticoagulants and proton pump inhibitor cotherapy with hospitalization for upper gastrointestinal tract bleeding. JAMA. 2018 Dec 4;320(21):2221-30.
Dr. Ho is an assistant professor of medicine in the division of general and hospital medicine at UT Health San Antonio and a hospitalist at South Texas Veterans Health Care System.
