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Article: Risk of hospitalization for upper gastrointestinal bleeding in Helicobacter pylori eradicated patients newly started on warfarin or direct oral anticoagulants: A population‐based cohort study

TitleRisk of hospitalization for upper gastrointestinal bleeding in <i>Helicobacter pylori</i> eradicated patients newly started on warfarin or direct oral anticoagulants: A population‐based cohort study
Authors
Keywordsdirect thrombin inhibitor
factor Xa inhibitor
gastrointestinal bleeding
Issue Date29-May-2023
PublisherWiley
Citation
Helicobacter, 2023, v. 28, n. 4 How to Cite?
Abstract

Background

To investigate risks of hospitalization for upper gastrointestinal bleeding (UGIB) in H. pylori-eradicated patients newly started on warfarin or direct oral anti-coagulants (DOACs).

Methods

We identified all patients who had previously received H. pylori eradication therapy or were found to have no H. pylori on endoscopy and were then newly started on warfarin or DOACs from a population-based electronic healthcare database. Primary analysis was the risk of UGIB between warfarin and DOACs users in H. pylori-eradicated patients. Secondary analysis included the UGIB risk between H. pylori-eradicated and H. pylori-negative patients who were newly started on warfarin or DOACs. The hazard ratio (HR) of UGIB was approximated by pooled logistic regression model incorporating the inverse propensity of treatment weightings with time-varying covariables.

Results

Among H. pylori-eradicated patients, DOACs had a significantly lower risk of UGIB (HR: 0.26, 95% CI 0.09–0.71) compared with warfarin. In particular, lower UGIB risks with DOACs were observed among older (65 years) patients, female, those without a history of UGIB or peptic ulcer, or ischemic heart disease, and non-users of acid-suppressive agents or aspirin. Secondary analysis showed no significant difference in UGIB risk between H. pylori-eradicated and H. pylori-negative patients newly started on warfarin (HR: 0.63,95% CI 0.33–1.19) or DOACs (HR: 1.37, 95% CI 0.45–4.22).

Conclusions

In H. pylori-eradicated patients, new users of DOACs had a significantly lower risk of UGIB than new warfarin users. Furthermore, the risk of UGIB in new warfarin or DOACs users was comparable between H. pylori-eradicated and H. pylori-negative patients.


Persistent Identifierhttp://hdl.handle.net/10722/340830
ISSN
2023 Impact Factor: 4.3
2023 SCImago Journal Rankings: 1.035
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorJiang, Fang-
dc.contributor.authorJu, Chengsheng-
dc.contributor.authorGuo, Chuan‐Guo-
dc.contributor.authorCheung, Ka Shing-
dc.contributor.authorLi, Bofei-
dc.contributor.authorLaw, Simon-
dc.contributor.authorLau, Wallis-
dc.contributor.authorLeung, Wai Keung-
dc.date.accessioned2024-03-11T10:47:36Z-
dc.date.available2024-03-11T10:47:36Z-
dc.date.issued2023-05-29-
dc.identifier.citationHelicobacter, 2023, v. 28, n. 4-
dc.identifier.issn1083-4389-
dc.identifier.urihttp://hdl.handle.net/10722/340830-
dc.description.abstract<h3>Background</h3><p>To investigate risks of hospitalization for upper gastrointestinal bleeding (UGIB) in <em>H. pylori</em>-eradicated patients newly started on warfarin or direct oral anti-coagulants (DOACs).</p><h3>Methods</h3><p>We identified all patients who had previously received <em>H. pylori</em> eradication therapy or were found to have no <em>H. pylori</em> on endoscopy and were then newly started on warfarin or DOACs from a population-based electronic healthcare database. Primary analysis was the risk of UGIB between warfarin and DOACs users in <em>H. pylori</em>-eradicated patients. Secondary analysis included the UGIB risk between <em>H. pylori</em>-eradicated and <em>H. pylori</em>-negative patients who were newly started on warfarin or DOACs. The hazard ratio (HR) of UGIB was approximated by pooled logistic regression model incorporating the inverse propensity of treatment weightings with time-varying covariables.</p><h3>Results</h3><p>Among <em>H. pylori</em>-eradicated patients, DOACs had a significantly lower risk of UGIB (HR: 0.26, 95% CI 0.09–0.71) compared with warfarin. In particular, lower UGIB risks with DOACs were observed among older (<strong>≥</strong>65 years) patients, female, those without a history of UGIB or peptic ulcer, or ischemic heart disease, and non-users of acid-suppressive agents or aspirin. Secondary analysis showed no significant difference in UGIB risk between <em>H. pylori</em>-eradicated and <em>H. pylori</em>-negative patients newly started on warfarin (HR: 0.63,95% CI 0.33–1.19) or DOACs (HR: 1.37, 95% CI 0.45–4.22).</p><h3>Conclusions</h3><p>In <em>H. pylori</em>-eradicated patients, new users of DOACs had a significantly lower risk of UGIB than new warfarin users. Furthermore, the risk of UGIB in new warfarin or DOACs users was comparable between <em>H. pylori</em>-eradicated and <em>H. pylori</em>-negative patients.</p>-
dc.languageeng-
dc.publisherWiley-
dc.relation.ispartofHelicobacter-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectdirect thrombin inhibitor-
dc.subjectfactor Xa inhibitor-
dc.subjectgastrointestinal bleeding-
dc.titleRisk of hospitalization for upper gastrointestinal bleeding in <i>Helicobacter pylori</i> eradicated patients newly started on warfarin or direct oral anticoagulants: A population‐based cohort study-
dc.typeArticle-
dc.identifier.doi10.1111/hel.12990-
dc.identifier.scopuseid_2-s2.0-85161009129-
dc.identifier.volume28-
dc.identifier.issue4-
dc.identifier.eissn1523-5378-
dc.identifier.isiWOS:000996147200001-
dc.identifier.issnl1083-4389-

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