David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) reviewing Ray WA et al. Gastroenterology 2016 Sep 14.

Proton-pump inhibitors reduced upper gastrointestinal bleeding, but by a significant amount only in patients also taking NSAIDs or antiplatelet agents.

Proton-pump inhibitors (PPIs) reduce the risk for upper gastrointestinal bleeding (UGIB) in patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) and antiplatelet agents (APAs). To assess the impact of PPIs on bleeding in patients taking warfarin, investigators performed a retrospective cohort study involving 97,430 patients in the Tennessee Medicaid database and the 5% National Medicare sample who were newly prescribed warfarin.

Analysis of 75,720 patient-years of follow-up data showed the following:

The rate of hospitalizations for UGIB (a primary endpoint) was lower by 24% in patients taking PPIs versus those not taking PPIs (adjusted hazard ratio, 0.76; 95% confidence interval, 0.63–0.91).

In patients also taking NSAIDs or APAs, the rate of hospitalizations for UGIB was lower by 45% in those taking PPIs (AHR, 0.55; 95% CI, 0.39–0.77); the reduction in UGIB with PPI use was only significant in these patients.

The impact of PPIs did not vary among specific NSAIDs or APAs.

In patients not taking PPIs, bleeding risk increased with risk factors for GI bleeding, NSAIDs, and APAs; in patients taking PPIs, these factors did not affect bleeding risk.

PPIs had no effect on other causes of bleeding.

The authors conclude that PPIs reduce hospitalizations for UGIB by 24% overall in patients taking warfarin, but significantly reduce this rate only in patients also taking NSAIDs or APAs.

CITATION(S):

Ray WA et al. Association of proton pump inhibitors with reduced risk of warfarin-related serious upper gastrointestinal bleeding. Gastroenterology 2016 Sep 14; [e-pub]. 

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