American researchers have demonstrated that during 754 389 person-years of anticoagulation treatment with apixaban, dabigatran, rivaroxaban, and warfarin, the risk of hospitalization for upper gastrointestinal tract bleeding was highest for rivaroxaban, but that the use of Proton Pump Inhibitors was associated with a significantly lower overall risk of gastrointestinal bleeding for all anticoagulants (incidence rate ratio, 0.66). During treatment without concurrent PPI therapy, the adjusted incidence of hospitalization for upper gastrointestinal tract bleeding was 115 per 10 000 person-years, whereas anticoagulant treatment with PPI therapy, the rate of bleeding was 76 per 10 000 person-years. For each individual anticoagulant, the incidence of hospitalization for upper gastrointestinal tract bleeding was lower among patients who were receiving PPI co-therapy. Food for thought – perhaps not all PPI treatment should be regarded as a target for deprescribing. The study, published in the JAMA can be read here.
In some cases, ongoing PPI treatment plays an important role
Dec 9, 2018