PMID- 33585113
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210216
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 13
IP  - 1
DP  - 2021 Jan 11
TI  - A Study of Proton Pump Inhibitors and Other Risk Factors in Warfarin-Associated 
      Gastrointestinal Bleeding.
PG  - e12624
LID - 10.7759/cureus.12624 [doi]
LID - e12624
AB  - Background Warfarin users are at increased risk for gastrointestinal bleeding 
      (GIB). History of GIB, stroke, cardiovascular or chronic kidney disease, age 
      greater than 65 years, and drug interaction with proton pump inhibitors (PPI) 
      have previously been identified as risk factors for GIB in warfarin users. We 
      hypothesized that concomitant use of warfarin and PPI would increase the 
      incidence of GIB relative to warfarin use alone. Methods We did a retrospective 
      review of medical records of 626 patients taking warfarin for at least two weeks. 
      Parameters including age, concomitant medication use (non-steroidal 
      anti-inflammatory drugs (NSAID), aspirin, selective serotonin reuptake inhibitors 
      (SSRIs), PPI, and anti-platelet drug), history of GIB, chronic renal failure 
      (CRF), and peptic ulcer disease (PUD) prior to warfarin use were analyzed. 
      Results Variables that increase the likelihood of bleeding in warfarin users 
      included aspirin, PPI, history of PUD, history of previous GIB, CRF, and elevated 
      prothrombin time (PT)/international normalized ratio (INR) values. Concomitant 
      antiplatelet use showed a slight increase in GIB but this was not statistically 
      significant (p=0.082). NSAID use and SSRI use were not associated with a higher 
      risk of GIB among warfarin users. Patients who are on PPI and warfarin 
      simultaneously are more likely to be on acetylsalicylic acid (ASA) or have a 
      history of PUD, GIB, or CRF, all of which are associated with increased 
      incidences of GIB. Conclusions Although concomitant use of warfarin and PPI 
      appears to be associated with an increased incidence of GIB, these patients are 
      more likely to have other risk factors that also increase the risk of a GIB 
      outcome. Therefore, the interaction between PPI and warfarin is clinically 
      insignificant.
CI  - Copyright (c) 2021, Tang et al.
FAU - Tang, Jevon
AU  - Tang J
AD  - Gastroenterology, Captain James A. Lovell Federal Health Care Center, North 
      Chicago, USA.
FAU - Sharma, Umesh
AU  - Sharma U
AD  - Gastroenterology, Captain James A. Lovell Federal Health Care Center, North 
      Chicago, USA.
FAU - Desai, Shreya
AU  - Desai S
AD  - Internal Medicine, Chicago Medical School/Rosalind Franklin University of 
      Medicine and Science, North Chicago, USA.
FAU - Molnar, Janos
AU  - Molnar J
AD  - Cardiology, Chicago Medical School/Rosalind Franklin University of Medicine and 
      Science, North Chicago, USA.
FAU - Perlmuter, Lawrence
AU  - Perlmuter L
AD  - Internal Medicine, Chicago Medical School/Rosalind Franklin University of 
      Medicine and Science, North Chicago, USA.
FAU - Feller, Axel
AU  - Feller A
AD  - Gastroenterology, Captain James A. Lovell Federal Health Care Center, North 
      Chicago, USA.
FAU - Shah, Pallavi
AU  - Shah P
AD  - Gastroenterology, Captain James A. Lovell Federal Health Care Center, North 
      Chicago, USA.
AD  - Internal Medicine, Chicago Medical School/Rosalind Franklin University of 
      Medicine and Science, North Chicago, USA.
LA  - eng
PT  - Journal Article
DEP - 20210111
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC7872495
OTO - NOTNLM
OT  - bleeding risks
OT  - drug-drug interactions
OT  - gastrointestinal bleeding
OT  - proton-pump inhibitor
OT  - warfarin
COIS- The authors have declared that no competing interests exist.
EDAT- 2021/02/16 06:00
MHDA- 2021/02/16 06:01
PMCR- 2021/01/11
CRDT- 2021/02/15 06:10
PHST- 2021/02/15 06:10 [entrez]
PHST- 2021/02/16 06:00 [pubmed]
PHST- 2021/02/16 06:01 [medline]
PHST- 2021/01/11 00:00 [pmc-release]
AID - 10.7759/cureus.12624 [doi]
PST - epublish
SO  - Cureus. 2021 Jan 11;13(1):e12624. doi: 10.7759/cureus.12624.