PMID- 33730289
OWN - NLM
STAT- MEDLINE
DCOM- 20220712
LR  - 20220726
IS  - 1573-7241 (Electronic)
IS  - 0920-3206 (Linking)
VI  - 36
IP  - 4
DP  - 2022 Aug
TI  - Proton Pump Inhibitor Co-Therapy in Patients with Atrial Fibrillation Treated 
      with Oral Anticoagulants and a Prior History of Upper Gastrointestinal Tract 
      Bleeding.
PG  - 679-689
LID - 10.1007/s10557-021-07170-6 [doi]
AB  - PURPOSE: The risk of gastrointestinal bleeding (GIB) can be mitigated by proton 
      pump inhibitor (PPI) co-therapy in patients with atrial fibrillation (AF) treated 
      with anticoagulants. We aimed to evaluate the effect of PPIs on the risk of GIB 
      in Asian patients with AF, treated with oral anticoagulants (OACs), and with a 
      prior history of upper GIB. METHODS: Using a nationwide claims database, 
      OAC-naive patients with AF and a history of upper GIB before initiating OAC 
      treatment between January 2010 and April 2018 were included. Patients were 
      categorized into 10 groups according to the index OAC (warfarin, rivaroxaban, 
      dabigatran, apixaban, and edoxaban) and whether or not they received PPI 
      co-therapy, and were followed up for incidence of major GIB. RESULTS: Among a 
      total of 42,048 patients, 40% were prescribed PPIs as co-therapy with OACs. Over 
      a median 0.6 years (interquartile ranges 0.2-1.7 years) of follow-up, rivaroxaban 
      use without PPIs showed the highest crude incidence of major GIB (2.62 per 100 
      person-years), followed by the use of warfarin without a PPI (2.20 per 100 
      person-years). Compared to the patients without PPI use, PPI co-therapy was 
      associated with a significantly lower risk of major GIB, by 40% and 36%, in the 
      rivaroxaban and warfarin groups, respectively. In dabigatran, apixaban, and 
      edoxaban users, PPI co-therapy did not show a significant reduction in the risk 
      of major GIB. CONCLUSION: Among patients with AF receiving anticoagulant 
      treatment and with a prior history of upper GIB, PPI co-therapy was associated 
      with a significant reduction in the risk of major GIB in patients treated with 
      rivaroxaban and warfarin.
CI  - (c) 2021. Springer Science+Business Media, LLC, part of Springer Nature.
FAU - Lee, So-Ryoung
AU  - Lee SR
AD  - Department of Internal Medicine, Seoul National University Hospital, Seoul, 
      Republic of Korea.
FAU - Kwon, Soonil
AU  - Kwon S
AD  - Department of Internal Medicine, Seoul National University Hospital, Seoul, 
      Republic of Korea.
FAU - Choi, Eue-Keun
AU  - Choi EK
AUID- ORCID: 0000-0002-0411-6372
AD  - Department of Internal Medicine, Seoul National University Hospital, Seoul, 
      Republic of Korea. choiek17@snu.ac.kr.
AD  - Department of Internal Medicine, Seoul National University College of Medicine, 
      Seoul, Republic of Korea. choiek17@snu.ac.kr.
FAU - Jung, Jin-Hyung
AU  - Jung JH
AD  - Department of Medical Statistics, College of Medicine, Catholic University of 
      Korea, Seoul, Republic of Korea.
FAU - Han, Kyung-Do
AU  - Han KD
AD  - Department of Statistics and Actuarial Science, Soongsil University, Seoul, 
      Republic of Korea.
FAU - Oh, Seil
AU  - Oh S
AD  - Department of Internal Medicine, Seoul National University Hospital, Seoul, 
      Republic of Korea.
AD  - Department of Internal Medicine, Seoul National University College of Medicine, 
      Seoul, Republic of Korea.
FAU - Lip, Gregory Y H
AU  - Lip GYH
AD  - Department of Internal Medicine, Seoul National University Hospital, Seoul, 
      Republic of Korea.
AD  - Liverpool Centre for Cardiovascular Science, University of Liverpool and 
      Liverpool Chest & Heart Hospital, Liverpool, UK.
AD  - Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
LA  - eng
GR  - 202013B14/The Korean government/
GR  - 2020R1F1A106740/The Korea National Research Foundation/
PT  - Journal Article
DEP - 20210317
PL  - United States
TA  - Cardiovasc Drugs Ther
JT  - Cardiovascular drugs and therapy
JID - 8712220
RN  - 0 (Anticoagulants)
RN  - 0 (Proton Pump Inhibitors)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9NDF7JZ4M3 (Rivaroxaban)
RN  - I0VM4M70GC (Dabigatran)
SB  - IM
MH  - Administration, Oral
MH  - Anticoagulants
MH  - *Atrial Fibrillation/diagnosis/drug therapy/epidemiology
MH  - Dabigatran
MH  - Gastrointestinal Hemorrhage/chemically induced/diagnosis/epidemiology
MH  - Humans
MH  - Proton Pump Inhibitors/adverse effects
MH  - Rivaroxaban
MH  - *Stroke/epidemiology
MH  - *Upper Gastrointestinal Tract
MH  - Warfarin
OTO - NOTNLM
OT  - Anticoagulation
OT  - Atrial fibrillation
OT  - Bleeding
OT  - Proton pump inhibitor
EDAT- 2021/03/18 06:00
MHDA- 2022/07/14 06:00
CRDT- 2021/03/17 17:47
PHST- 2021/03/01 00:00 [accepted]
PHST- 2021/03/18 06:00 [pubmed]
PHST- 2022/07/14 06:00 [medline]
PHST- 2021/03/17 17:47 [entrez]
AID - 10.1007/s10557-021-07170-6 [pii]
AID - 10.1007/s10557-021-07170-6 [doi]
PST - ppublish
SO  - Cardiovasc Drugs Ther. 2022 Aug;36(4):679-689. doi: 10.1007/s10557-021-07170-6. 
      Epub 2021 Mar 17.