Non-vitamin K antagonist oral anticoagulants, proton pump inhibitors and gastrointestinal bleeds
| Autor: | Komen, Joris, Pottegård, Anton, Hjemdahl, Paul, Mantel-Teeuwisse, Aukje K., Wettermark, Björn, Hellfritzsch, Maja, Hallas, J., Herings, Ron, Smits, Lisa, Forslund, Thomas, Klungel, Olaf, Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology |
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| Přispěvatelé: | Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, Epidemiology and Data Science, Neurology |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class Administration Oral Proton-pump inhibitor 030204 cardiovascular system & hematology Cohort Studies 03 medical and health sciences symbols.namesake 0302 clinical medicine Risk Factors Internal medicine Atrial Fibrillation medicine Humans atrial fibrillation Cardiac and Cardiovascular Systems oral anticoagulants 030212 general & internal medicine Poisson regression Aged Aged 80 and over Kardiologi business.industry Anticoagulants Proton Pump Inhibitors Atrial fibrillation Vitamin K antagonist medicine.disease Stroke Concomitant symbols Number needed to treat Upper gastrointestinal bleeding Gastrointestinal Hemorrhage Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors Cohort study |
| Zdroj: | Komen, J, Pottegard, A, Hjemdahl, P, Mantel-Teeuwisse, A K, Wettermark, B, Hellfritzsch, M, Hallas, J, Herings, R, Smits, L, Forslund, T & Klungel, O 2021, ' Non-vitamin K antagonist oral anticoagulants, proton pump inhibitors and gastrointestinal bleeds ', Heart . https://doi.org/10.1136/heartjnl-2021-319332 Heart. BMJ Publishing Group Heart, 108, 613. BMJ Publishing Group |
| ISSN: | 1468-201X 1355-6037 |
| DOI: | 10.1136/heartjnl-2021-319332 |
| Popis: | ObjectiveTo evaluate if proton pump inhibitor (PPI) treatment reduces the risk of upper gastrointestinal bleeding (UGIB) in patients with atrial fibrillation (AF) treated with non-vitamin K antagonist oral anticoagulants (NOACs).DesignWe used a common protocol, common data model approach to conduct a cohort study including patients with AF initiated on a NOAC in Stockholm, Denmark and the Netherlands from April 2011 until July 2018. The outcome of interest was a UGIB diagnosed in a secondary care inpatient setting. We used an inverse probability weighted (IPW) Poisson regression to calculate incidence rate ratios (IRRs), contrasting PPI use to no PPI use periods.ResultsIn 164 290 NOAC users with AF, providing 272 570 years of follow-up and 39 938 years of PPI exposure, 806 patients suffered a UGIB. After IPW, PPI use was associated with lower UGIB rates (IRR: 0.75; 95% CI: 0.59 to 0.95). On an absolute scale, the protective effect was modest, and was found to be largest in high-risk patients, classified as age 75–84 years (number needed to treat for 1 year (NNTY): 787), age ≥85 years (NNTY: 667), HAS-BLED score ≥3 (NNTY: 378) or on concomitant antiplatelet therapy (NNTY: 373).ConclusionConcomitant treatment with a PPI in NOAC-treated patients with AF is associated with a reduced risk of severe UGIB. This indicates that PPI cotreatment can be considered, in particular among the elderly patients, patients with a HAS-BLED score ≥3, and/or in patients on concomitant antiplatelet therapy. |
| Databáze: | OpenAIRE |
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