Protective effect of proton pump inhibitor (PPI) against gastrointestinal bleeding in patients receiving oral anticoagulants (oral anticoagulant therapy)

A meta-analysis was undertaken to estimate the risk of GIB (gastrointestinal bleeding) in patients with OAC (oral anticoagulants) and PPI (proton pump inhibitor) co-therapy:

• review (10 studies, n=1,970,931) found PPI co-therapy linked to lower odds of total (OR 0.67; 95% CI 0.62-0.74) and major (0.68; 0.63-0.75) GI bleeding
  • for all kinds of OAC except for edoxaban, PPI cotreatment was related to a lower odds of GIB by 24-44%
  • the protective effect of PPI on total GIB was more significant in concurrent antiplatelets or non-steroidal anti-inflammatory drug users and those with high bleeding risks: patients with previous GIB history, HAS-BLED >= 3, or underlying gastrointestinal diseases
• study authors concluded:
  • in patients who receive OAC, PPI co-therapy is associated with a lower total and major GIB irrespective of ethnic group and OAC type, except for edoxaban
  • PPI co-therapy can be considered particularly in high GIB risk patients

Reference:

• Ahn HJ, Lee SR, Choi EK, Rhee TM, Kwon S, Oh S, Lip GYH. Protective effect of proton pump inhibitor against gastrointestinal bleeding in patients receiving oral anticoagulants: A systematic review and meta-analysis. Br J Clin Pharmacol. 2022 Aug 3. doi: 10.1111/bcp.15478.