The association between proton pump inhibitors and the risk of gastrointestinal bleeding in oral anticoagulants users
Current evidence of whether proton pump inhibitor (PPI) reduces the risk of gastrointestinal bleeding (GIB) associated with oral anticoagulants (OACs) is limited. Propensity score-weighted cohort and case-crossover studies were conducted separately in England and Hong Kong between 2011.01.01 and 2019.12.31. In the cohort design, we compared the hazards of hospitalised GIB in <b><i>OAC</i></b> + <b><i>PPI</i></b> users with <b><i>OAC only</i></b> users in people with atrial fibrillation and found higher hazard of GIB in <b><i>OAC</i></b> + <b><i>PPI</i></b> users in both settings. In the case-crossover design, elevated odds of exposure to <b><i>PPI only</i></b> , <b><i>OAC only</i></b> and <b><i>OAC</i></b> + <b><i>PPI</i></b> associated with GIB between 30-day hazard and referent periods were similarly found in both settings. Overall, the evidence of an elevated risk of <b><i>OAC</i></b> + <b><i>PPI</i></b> associated with GIB compared with <b><i>OAC only</i></b> was modest in the cohort study. Our case-crossover study suggested that residual confounding is likely to explain the association, suggesting that concomitant prescription of PPI with OAC did not modify GIB.
Authors
- Charlotte Warren‐Gash (ORCID: https://orcid.org/0000-0003-4524-3180)
- Celine Sze Ling Chui (ORCID: https://orcid.org/0000-0003-1513-8726)
- Angel Y. S. Wong (ORCID: https://orcid.org/0000-0002-8618-7333)
- Zixuan Wang (ORCID: https://orcid.org/0000-0001-5345-2471)
- Liam Smeeth (ORCID: https://orcid.org/0000-0002-9168-6022)
- Esther W. Chan (ORCID: https://orcid.org/0000-0002-7602-9470)
- Krishnan Bhaskaran (ORCID: https://orcid.org/0000-0001-5364-8757)
- Ka Shing Cheung (ORCID: https://orcid.org/0000-0002-4838-378X)
- Ian Douglas (ORCID: https://orcid.org/0000-0002-8970-1406)
- Qiuyan Yu (ORCID: https://orcid.org/0000-0002-5385-7185)
- Amitava Banerjee (ORCID: https://orcid.org/0000-0001-8741-3411)
- Ian Chi Kei Wong (ORCID: https://orcid.org/0000-0001-8242-0014)
- Clémence Leyrat (ORCID: https://orcid.org/0000-0002-4097-4577)
Institutions
- Aston University (GB)
- Queen Mary Hospital (CN)
- Hong Kong Science and Technology Parks Corporation (HK)
- University College Birmingham (GB)
- London School of Hygiene & Tropical Medicine (GB)
- University of Hong Kong - Shenzhen Hospital (CN)
- Farr Institute (GB)
- Laboratory of Data Discovery for Health (HK)
- University College London (GB)
- University of Birmingham (GB)
- University of Hong Kong (HK)
Publication Details
- Journal
- npj Cardiovascular Health
- Published
- 2025-04-12
- DOI
- https://doi.org/10.1038/s44325-024-00037-3
- Citations
- 1
- Primary Topic
- Atrial Fibrillation Management and Outcomes
- Type
- article
- Field-Weighted Citation Impact
- 1.39
Funders
- UK Research and Innovation
- National Institute for Health and Care Research
- British Heart Foundation
- Diabetes UK
- Innovation and Technology Commission
- Medical Research Council