Proton Pump Inhibitors to The Reduce Risk of Upper Gastrointestinal Bleeding in Patients Using Warfarin
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Abstract
Background: Upper gastrointestinal bleeding is one of the most common side effects among patients using anticoagulants. The combination of anticoagulants with proton pump inhibitors (PPI) has also been used in patients who appear to be at risk for upper gastrointestinal bleeding. However, evidence of efficacy for this indication is limited.
Objectives: To compare upper gastrointestinal bleeding and the major bleeding as well as side effects in other sites during anticoagulant use, with and without PPI co-therapy.
Materials and methods: This work involved a retrospective cohort study of patients who started warfarin treatment at Banglamung Hospital between 1 January 2015 and 31 December 2018.
Results: The study enrolled 207 participants comprised of 87 patients who took warfarin with omeprazole co-therapy and 120 controls. The HAS-BLED score did not differ between the two groups. In terms of omeprazole co-therapy, the ratios for upper gastrointestinal tract bleeding (UGIB), non-UGIB major bleeding, and death were 9.2%, 10.3%, and 14.9%, respectively, while those of the control group were 5%, 5.8%, and 9.2%, respectively. The hazard ratios were 2.07 (95%Confidence interval [CI] 0.71-6.03, P 0.18) for UGIB, 1.83 (95%CI 0.68-4.93, P 0.23) for non-UGIB major bleeding, and 1.65 (95%CI 0.74-3.67, P 0.22) for death.
Conclusion: There was no significant reduction in UGIB or non-UGIB major bleeding in patients with warfarin and omeprazole co-therapy when compared with control.
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References
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