PMID- 23800296
OWN - NLM
STAT- MEDLINE
DCOM- 20131029
LR  - 20220321
IS  - 1365-2796 (Electronic)
IS  - 0954-6820 (Linking)
VI  - 274
IP  - 4
DP  - 2013 Oct
TI  - Low-dose acetylsalicylic acid and gastrointestinal ulcers or bleeding--a cohort 
      study of the effects of proton pump inhibitor use patterns.
PG  - 371-80
LID - 10.1111/joim.12103 [doi]
AB  - OBJECTIVE: The aim of this study was to investigate the associations between 
      proton pump inhibitor (PPI) usage patterns and risk of severe gastrointestinal 
      events in patients treated with low-dose acetylsalicylic acid (LDA). DESIGN AND 
      SETTING: A nationwide cohort study in Sweden. PATIENTS: All Swedish residents >/= 
      40 years of age, without cancer and receiving LDA treatment (>/= 80% adherence for 
      365 days between 2005 and 2009) were identified in the Swedish Prescription 
      Register. Continuous PPI use was defined as > 60 of 90 days covered by daily PPI 
      doses and further divided into high (>/= 80%) or moderate (< 80) adherence. All 
      other PPI use was defined as intermittent use. MAIN OUTCOME MEASURES: The risk of 
      a combined end-point of gastrointestinal ulcer or bleeding was analysed using Cox 
      proportional hazard models. We also investigated risk of > 45 days of LDA 
      treatment interruption. RESULTS: During a median follow-up of 2.5 years, 7880 of 
      648,807 (1.2%) LDA-treated patients experienced gastrointestinal events. In 
      multivariable-adjusted models, both intermittent-PPI and no-PPI use were 
      associated with increased risk of gastrointestinal ulcers or bleeding compared 
      with continuous PPI use with a high level of adherence [hazard ratio (HR) 1.83 
      (95% CI 1.66-2.02) and 1.14 (95% CI 1.05-1.23), respectively]. Amongst continuous 
      PPI users, moderate adherence also increased the risk of gastrointestinal ulcers 
      or bleeding [HR 1.22 (95% CI 1.07-1.40)]. The risk of LDA treatment interruption 
      was higher with intermittent PPI use [HR 1.16 (95% CI 1.14-1.19)] than continuous 
      PPI use with high adherence. CONCLUSIONS: In this large cohort of LDA users, 
      intermittent PPI use was associated with higher risk of gastrointestinal ulcers 
      or bleeding and interrupted LDA treatment, compared with continuous PPI use.
CI  - (c) 2013 The Association for the Publication of the Journal of Internal Medicine.
FAU - Hedberg, J
AU  - Hedberg J
AD  - Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
FAU - Sundstrom, J
AU  - Sundstrom J
FAU - Thuresson, M
AU  - Thuresson M
FAU - Aarskog, P
AU  - Aarskog P
FAU - Oldgren, J
AU  - Oldgren J
FAU - Bodegard, J
AU  - Bodegard J
LA  - eng
PT  - Journal Article
DEP - 20130710
PL  - England
TA  - J Intern Med
JT  - Journal of internal medicine
JID - 8904841
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Drug Combinations)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Aged
MH  - Anti-Inflammatory Agents, Non-Steroidal/*adverse effects
MH  - Aspirin/*adverse effects
MH  - Cohort Studies
MH  - Dose-Response Relationship, Drug
MH  - Drug Combinations
MH  - Drug Utilization
MH  - Female
MH  - Follow-Up Studies
MH  - Gastrointestinal Hemorrhage/*chemically induced
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Peptic Ulcer/*chemically induced
MH  - Platelet Aggregation Inhibitors/*adverse effects
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Sweden
OTO - NOTNLM
OT  - acetylsalicylic acid
OT  - medication adherence
OT  - peptic ulcer
OT  - prophylaxis
OT  - proton pump inhibitors
EDAT- 2013/06/27 06:00
MHDA- 2013/10/30 06:00
CRDT- 2013/06/27 06:00
PHST- 2013/06/27 06:00 [entrez]
PHST- 2013/06/27 06:00 [pubmed]
PHST- 2013/10/30 06:00 [medline]
AID - 10.1111/joim.12103 [doi]
PST - ppublish
SO  - J Intern Med. 2013 Oct;274(4):371-80. doi: 10.1111/joim.12103. Epub 2013 Jul 10.