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

Abstract

<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 <strong><em>OAC</em></strong> + <strong><em>PPI</em></strong> users with <strong><em>OAC only</em></strong> users in people with atrial fibrillation and found higher hazard of GIB in <strong><em>OAC</em></strong> + <strong><em>PPI</em></strong> users in both settings. In the case-crossover design, elevated odds of exposure to <strong><em>PPI only</em></strong>, <strong><em>OAC only</em></strong> and <strong><em>OAC</em></strong> + <strong><em>PPI</em></strong> associated with GIB between 30-day hazard and referent periods were similarly found in both settings. Overall, the evidence of an elevated risk of <strong><em>OAC</em></strong> + <strong><em>PPI</em></strong> associated with GIB compared with <strong><em>OAC only</em></strong> 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.<br></p>