S1440 Vonoprazan Versus Proton Pump Inhibitors for Gastroprotection in Anticoagulated Patients: Real-World Outcomes From a Propensity-Matched Cohort Study

Introduction: Patients receiving oral anticoagulation therapy, including warfarin and direct oral anticoagulants (DOACs), have an increased risk of gastrointestinal (GI) bleeding. Proton pump inhibitors (PPIs) have traditionally been the standard agents used for gastroprotection in high risk patients. Vonoprazan, a novel potassium-competitive acid blocker, provides rapid and sustained gastric acid suppression. However, comparative real-world data evaluating vonoprazan versus PPIs specifically in anticoagulated patients are limited. This study aimed to evaluate clinical outcomes, including GI bleeding, mortality, and transfusion rates, in patients on anticoagulation treated with vonoprazan versus PPIs. Methods: We conducted a retrospective cohort study utilizing the TriNetX database to identify adult patients receiving oral anticoagulation therapy who were prescribed either vonoprazan or a PPI. Propensity score matching was used to balance baseline characteristics between cohorts, including indications for starting acid suppression medications. Outcomes were analyzed at a one-year follow-up post-index prescription. The primary outcome was GI bleeding. Secondary outcomes included all-cause mortality, rates of blood transfusion, and comparative hemoglobin levels between both cohorts. Results: Among the matched cohorts, each consisting of 3,107 patients, GI bleeding incidences were lower in the vonoprazan group compared to the PPI group (1.96% vs 3.18%; OR 0.608; 95% CI, 0.433–0.856; P = 0.0039). Additionally, all-cause mortality was lower among patients treated with vonoprazan compared to PPIs (5.7% vs 9.38%; OR 0.584; 95% CI, 0.481–0.709; P < 0.0001). Blood transfusion incidences were also lower in the vonoprazan cohort (0.33% vs 0.88%; OR 0.367; 95% CI, 0.177–0.759; P = 0.0048). Furthermore, mean hemoglobin levels at one year were higher in the vonoprazan group compared to the PPI group (11.76 ± 2.13 g/dL vs 11.54 ± 2.34 g/dL; P = 0.0006). Conclusion: In this real-world study of patients on anticoagulation, vonoprazan was associated with a lower incidence of GI bleeding, reduced all-cause mortality, less blood transfusion events, and improved hemoglobin levels compared to PPIs. These findings suggest vonoprazan may provide superior gastroprotection and clinical benefits over traditional PPIs in high risk anticoagulated populations.