Acid Suppressants Reduce Risk of Gastrointestinal Bleeding in Patients on Antithrombotic or Anti-Inflammatory Therapy.
Gastroenterology. 2011 Mar 30;
Authors: Lin KJ, Hernández-Díaz S, Rodríguez LA
BACKGROUND & AIMS:: We investigated the effect of different prevention strategies against upper gastrointestinal bleeding (UGIB) in the general population and in patients on anti-thrombotic or anti-inflammatory treatments. METHODS:: We performed a population-based, nested, case-control study using The Health Improvement Network UK primary care database. From 2000 to 2007, we identified 2049 cases of UGIB and 20,000 controls. The relative risk (RR) of UGIB associated with various gastroprotective agents was estimated by comparing current use (defined as use within 30 days of the index date) with non-use in the previous year, using multivariate logistic regression. RESULTS:: The adjusted RR of UGIB associated with current use of proton pump inhibitors (PPIs) for >1 month was 0.58 (95% confidence interval [CI], 0.42-0.79) among patients that received low-dose acetylsalicylic acid (ASA), 0.18 (0.04-0.79) for clopidogrel, 0.17 (0.04-0.76) for dual anti-platelet therapy, 0.48 (0.22-1.04) for warfarin, and 0.51 (0.34-0.78) for non-steroidal anti-inflammatory drugs. The corresponding estimates for therapy with histamine-2 receptor antagonists (H2RAs) were more unstable, but tended to be of a smaller magnitude. In the general population, PPI use was associated with a reduced risk of UGIB, compared with non-use (RR, 0.80; 95% CI, 0.68-0.94); no such reduction was observed for H2RAs or nitrates. CONCLUSION:: PPI use for over 1 month was associated with a lower risk of UGIB in the general population and in patients on antithrombotic or anti-inflammatory therapy, compared with non-use of PPIs. The reduction in risks of UGIB of was smaller in H2RA than in PPI users.
PMID: 21458456 [PubMed - as supplied by publisher]