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PPIs linked to lower risk for warfarin-related upper GI bleeding
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Co-therapy with proton pump inhibitors was associated with a reduced risk for upper gastrointestinal bleeding in patients beginning warfarin treatment, particularly in those also taking antiplatelet drugs or NSAIDs, according to research published in Gastroenterology.
“Our observational study shows a 24% decreased risk with PPIs,” Wayne A. Ray, PhD, from the department of health policy at Vanderbilt University School of Medicine, told Healio Gastroenterology. “The risk decrease was most pronounced for those on NSAIDs and antiplatelets, with nearly a threefold increase in [upper GI bleeding] risk, which PPIs reduced by 45%.”
Wayne A. Ray
Ray and colleagues used Tennessee Medicaid records and the 5% National Medicare Sample to perform a retrospective cohort study of 97,430 patients beginning warfarin treatment with 75,720 person-years of follow-up, and evaluated for concurrent medication use and bleeding-related hospitalizations.
Patients taking warfarin without concurrent PPIs had 119 hospitalizations for upper GI bleeding per 10,000 person-years of treatment, while patients who did take concurrent PPIs had a 24% lower risk (adjusted HR = 0.76; 95% CI, 0.63-0.91), with a corresponding reduction of 29 hospitalizations per 10,000 person-years. Risks for other GI bleeding or non-GI bleeding hospitalizations were not significantly reduced in those taking PPIs.
Furthermore, patients using concurrent antiplatelets or NSAIDs had 283 hospitalizations for upper GI bleeding per 10,000 person-years of warfarin treatment, while patients who took PPIs concurrently had a 45% lower risk (HR = 0.55; 95% CI, 0.39-0.77), with a corresponding reduction of 128 hospitalizations per 10,000 person-years. PPI co-therapy had no significant gastroprotective effect for warfarin patients not using antiplatelets or NSAIDs.
PPIs may prevent warfarin-related upper GI bleeding “by decreasing the occurrence of spontaneous ulcers or promoting ulcer healing before serious bleeding occurs,” but evidence is limited and therefore guidelines do not currently recommend them, Ray and colleagues wrote. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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