TY - JOUR
T1 - Non-vitamin K antagonist oral anticoagulants, proton pump inhibitors and gastrointestinal bleeds
AU - Komen, Joris
AU - Pottegård, Anton
AU - Hjemdahl, Paul
AU - Mantel-Teeuwisse, Aukje K.
AU - Wettermark, Björn
AU - Hellfritzsch, Maja
AU - Hallas, J.
AU - Herings, Ron
AU - Smits, Lisa
AU - Forslund, Thomas
AU - Klungel, Olaf
N1 - Funding Information:
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests JK reports personal fees from Boehringer Ingelheim, outside the submitted work. AP reports grants from Alcon, grants from Almirall, grants from Astellas, grants from AstraZeneca, grants from Boehringer Ingelheim, grants from Novo Nordisk, grants from Servier, grants from LEO Pharma, outside the submitted work. JH reports grants from AstraZeneca, outside the submitted work. RH and LS report other fees from University of Utrecht, during the conduct of the study.
Publisher Copyright:
©
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Objective To evaluate if proton pump inhibitor (PPI) treatment reduces the risk of upper gastrointestinal bleeding (UGIB) in patients with atrial fibrillation (AF) treated with non-vitamin K antagonist oral anticoagulants (NOACs). Design We used a common protocol, common data model approach to conduct a cohort study including patients with AF initiated on a NOAC in Stockholm, Denmark and the Netherlands from April 2011 until July 2018. The outcome of interest was a UGIB diagnosed in a secondary care inpatient setting. We used an inverse probability weighted (IPW) Poisson regression to calculate incidence rate ratios (IRRs), contrasting PPI use to no PPI use periods. Results In 164 290 NOAC users with AF, providing 272 570 years of follow-up and 39 938 years of PPI exposure, 806 patients suffered a UGIB. After IPW, PPI use was associated with lower UGIB rates (IRR: 0.75; 95% CI: 0.59 to 0.95). On an absolute scale, the protective effect was modest, and was found to be largest in high-risk patients, classified as age 75-84 years (number needed to treat for 1 year (NNTY): 787), age ≥85 years (NNTY: 667), HAS-BLED score ≥3 (NNTY: 378) or on concomitant antiplatelet therapy (NNTY: 373). Conclusion Concomitant treatment with a PPI in NOAC-treated patients with AF is associated with a reduced risk of severe UGIB. This indicates that PPI cotreatment can be considered, in particular among the elderly patients, patients with a HAS-BLED score ≥3, and/or in patients on concomitant antiplatelet therapy.
AB - Objective To evaluate if proton pump inhibitor (PPI) treatment reduces the risk of upper gastrointestinal bleeding (UGIB) in patients with atrial fibrillation (AF) treated with non-vitamin K antagonist oral anticoagulants (NOACs). Design We used a common protocol, common data model approach to conduct a cohort study including patients with AF initiated on a NOAC in Stockholm, Denmark and the Netherlands from April 2011 until July 2018. The outcome of interest was a UGIB diagnosed in a secondary care inpatient setting. We used an inverse probability weighted (IPW) Poisson regression to calculate incidence rate ratios (IRRs), contrasting PPI use to no PPI use periods. Results In 164 290 NOAC users with AF, providing 272 570 years of follow-up and 39 938 years of PPI exposure, 806 patients suffered a UGIB. After IPW, PPI use was associated with lower UGIB rates (IRR: 0.75; 95% CI: 0.59 to 0.95). On an absolute scale, the protective effect was modest, and was found to be largest in high-risk patients, classified as age 75-84 years (number needed to treat for 1 year (NNTY): 787), age ≥85 years (NNTY: 667), HAS-BLED score ≥3 (NNTY: 378) or on concomitant antiplatelet therapy (NNTY: 373). Conclusion Concomitant treatment with a PPI in NOAC-treated patients with AF is associated with a reduced risk of severe UGIB. This indicates that PPI cotreatment can be considered, in particular among the elderly patients, patients with a HAS-BLED score ≥3, and/or in patients on concomitant antiplatelet therapy.
KW - atrial fibrillation
KW - oral anticoagulants
UR - https://www.scopus.com/pages/publications/85113132606
U2 - 10.1136/heartjnl-2021-319332
DO - 10.1136/heartjnl-2021-319332
M3 - Article
C2 - 34340993
AN - SCOPUS:85113132606
SN - 1355-6037
VL - 108
SP - 613
EP - 618
JO - Heart
JF - Heart
IS - 8
ER -