Presentation Details
| Incidence of Gastrointestinal Bleeding in High-Risk Cardiovascular Patients Taking Antithrombotic Medications with Proton Pump Inhibitors Mark Edwards1, Xiaowen Kong1, Jacob Kurlander1, Scott Kaatz2, James B Froehlich1, Twylla Tassava3, Christopher Giuliano4, Geoffrey D Barnes1. 1University of Michigan-Michigan Medicine, Ann Arbor, MI, USA.2Henry Ford Health- Division of Hospital Medicine, Detroit, MI, USA.3Trinity Health-Ann Arbor, Ann Arbor, MI, USA.4Ascension- St.John Hospital, Detroit, MI, USA |
Abstract
Background: Individuals who use concurrent anticoagulant and antiplatelet (APT) medications are at increased risk for gastrointestinal (GI) bleeding. It is unclear if the addition of a proton pump inhibitor (PPI) can reduce the risk of a first GI bleed among patients treated with direct oral anticoagulants (DOAC) also taking APT. Objectives: The primary objective was to assess whether the incorporation of PPIs contributed to a reduced risk of experiencing a first gastrointestinal bleeding event among patients taking DOAC and APT. Methods: Medical record data from four centers participating in the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) registry was reviewed for patients prescribed a DOAC plus APT at baseline. Patients were excluded if they used non-treatment doses of a DOAC, had less than 6 months of follow up, or had prior GI bleeding. Two groups were identified for comparative analysis, (1) the DOAC and APT group (N=1172) and (2) the DOAC and APT + PPI group (N=601). Inverse probability of treatment weighting was used to adjust for baseline differences, and time-to-first-event analysis was conducted on the weighted populations. Results: During follow up, there were 216 GI bleeding events, 75 major GI bleeding events, 113 emergency department visits for GI bleeding, and 108 hospitalizations for GI bleeding. Patient demographics were analyzed for two groups: one receiving DOAC and APT (N=1172) and the other receiving DOAC, APT, and PPI (N=601). The groups were comparable in terms of age, gender, BMI, and comorbidities. After adjustment, there was no statistically significant difference in the time to first GI bleeding or other GI bleeding related outcome. Conclusion: The use of a PPI was not associated with a reduced risk of GI bleeding in this retrospective analysis. Randomized trials are needed to determine if PPI therapy can reduce GI bleeding risk in this population.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.