Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Cardiovasc Drugs Ther. 2022 Aug;36(4):679-689. doi: 10.1007/s10557-021-07170-6. Epub 2021 Mar 17.
The risk of gastrointestinal bleeding (GIB) can be mitigated by proton pump inhibitor (PPI) co-therapy in patients with atrial fibrillation (AF) treated with anticoagulants. We aimed to evaluate the effect of PPIs on the risk of GIB in Asian patients with AF, treated with oral anticoagulants (OACs), and with a prior history of upper GIB.
Using a nationwide claims database, OAC-naïve patients with AF and a history of upper GIB before initiating OAC treatment between January 2010 and April 2018 were included. Patients were categorized into 10 groups according to the index OAC (warfarin, rivaroxaban, dabigatran, apixaban, and edoxaban) and whether or not they received PPI co-therapy, and were followed up for incidence of major GIB.
Among a total of 42,048 patients, 40% were prescribed PPIs as co-therapy with OACs. Over a median 0.6 years (interquartile ranges 0.2-1.7 years) of follow-up, rivaroxaban use without PPIs showed the highest crude incidence of major GIB (2.62 per 100 person-years), followed by the use of warfarin without a PPI (2.20 per 100 person-years). Compared to the patients without PPI use, PPI co-therapy was associated with a significantly lower risk of major GIB, by 40% and 36%, in the rivaroxaban and warfarin groups, respectively. In dabigatran, apixaban, and edoxaban users, PPI co-therapy did not show a significant reduction in the risk of major GIB.
Among patients with AF receiving anticoagulant treatment and with a prior history of upper GIB, PPI co-therapy was associated with a significant reduction in the risk of major GIB in patients treated with rivaroxaban and warfarin.
质子泵抑制剂（PPI）与抗凝剂联合治疗可降低房颤（AF）患者胃肠道出血（GIB）的风险。我们旨在评估 PPI 在接受口服抗凝剂（OAC）治疗且既往有上消化道出血（GIB）史的亚洲 AF 患者中的应用对 GIB 风险的影响。
使用全国性的索赔数据库，纳入 2010 年 1 月至 2018 年 4 月期间开始 OAC 治疗前有 AF 病史且有上消化道出血（GIB）病史的 OAC 初治患者。根据指数 OAC（华法林、利伐沙班、达比加群、阿哌沙班和依度沙班）和是否联合应用 PPI ，将患者分为 10 组，并随访主要 GIB 的发生率。
在总共 42048 名患者中，40%的患者联合 OAC 应用 PPI。中位随访 0.6 年（四分位距 0.2-1.7 年）期间，未应用 PPI 的利伐沙班组主要 GIB 的粗发生率最高（2.62/100 人年），其次是未应用 PPI 的华法林组（2.20/100 人年）。与未应用 PPI 的患者相比，利伐沙班和华法林组中 PPI 联合治疗分别显著降低了 40%和 36%的主要 GIB 风险。在达比加群、阿哌沙班和依度沙班使用者中，PPI 联合治疗并未显著降低主要 GIB 的风险。
在接受抗凝治疗且既往有上消化道出血（GIB）病史的 AF 患者中，PPI 联合治疗可显著降低利伐沙班和华法林治疗患者的主要 GIB 风险。
