PPI use beneficial to Asian AF patients on direct oral anticoagulant

Proton pump inhibitor (PPI) co-therapy appears to lower the risk of hospitalization for upper gastrointestinal bleeding (UGIB) in atrial fibrillation (AF) patients receiving direct oral anticoagulant (DOAC) treatment, according to a study from Korea.

For the study, researchers used data from the Korean Health Insurance Review and Assessment database. A total of 165,624 patients (mean age 72 years, mean CHA2DS2-VASc score 4.3, mean HAS-BLED score 3.3) were included. The propensity score (PS) weighting method was used to compare the primary outcome of hospitalization for UGIB between patients with PPI use and those without PPI use.

Of the patients, 65,756 used PPI and 99,868 did not. The median follow-up was 1.5 years.

Multivariable Cox proportional hazards regression model showed that compared with nonuse, PPIuse was associated with lower risks of hospitalization for UGIB (weighted hazard ratio [HR], 0.825, 95 percent confidence interval [CI], 0.761–0.894; p<0.001) and UGIB requiring red blood cell transfusion (weighted HR, 0.798, 95 percent CI, 0.717–0.887; p<0.001).

Notably, the benefits of PPI on the risk of hospitalization for UGIB were greater in patients who were ≥75 years of age, had higher HAS-BLED score (≥3), prior UGIB history, and concomitant use of antiplatelet agent.

Low-dose PPI showed consistent association with a lower risk of significant UGIB (adjusted HR, 0.564, 95 percent CI, 0.504–0.631; p<0.001).