PPIs reduce upper GI bleeding in patients on anticoagulants

Use of proton pump inhibitors (PPIs) helps prevent upper gastrointestinal (GI) bleeding in patients using oral anticoagulants, reveals a study.

“The benefit appears to be most clearcut and substantial in patients with elevated risk of upper GI bleeding,” the authors said.

The databases of Embase, PubMed, Web of Science, Scopus, the Cochrane Library, and clinicaltrials.gov were searched until April 2021 for controlled randomized trials and observational studies reporting on the association of PPIs or H2-receptor antagonists with overt upper GI bleeding in patients using anticoagulants.

The authors then performed independent duplicate review, data extraction, and risk of bias assessment. They included observational studies only if results controlled for at least two variables were provided. Finally, meta-analyses were carried out through random effects models.

The search yielded six observational studies and one randomized trial, all of which had low risk of bias except for one study. None of these articles excluded patients with concomitant aspirin or nonsteroidal anti-inflammatory drug (NSAID) use.

The pooled relative risk of upper GI bleeding for PPIs was 0.67 (95 percent confidence interval [CI], 0.61‒0.74), with low statistical heterogeneity (I², 15 percent). Furthermore, individual studies reported better treatment effect in those with a higher risk for upper GI bleeding (eg, NSAID or aspirin use, elevated bleeding risk score).

One observational study that assessed the relationship between H2-receptor antagonists and upper GI bleeding revealed a relative risk of 0.69 (95 percent CI, 0.24‒2.02).