Effect of Proton Pump Inhibitors on Risks of Upper and Lower Gastrointestinal Bleeding among Users of Low-Dose Aspirin: A Population-Based Observational Study
Estimates of the effect of proton pump inhibitors (PPIs) on risks of upper and lower gastrointestinal bleeding (UGIB and LGIB) among low-dose aspirin users in routine clinical practice are variable (UGIB) or lacking (LGIB). We aimed to establish these risks in the same observational study population...
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doaj-6031fc73e0eb4e6fa305c1f633f3e9a42020-11-25T02:23:05ZengMDPI AGJournal of Clinical Medicine2077-03832020-03-01992892810.3390/jcm9040928Effect of Proton Pump Inhibitors on Risks of Upper and Lower Gastrointestinal Bleeding among Users of Low-Dose Aspirin: A Population-Based Observational StudyLuis A. García Rodríguez0Angel Lanas1Montse Soriano-Gabarró2Pareen Vora3Lucía Cea Soriano4Spanish Centre for Pharmacoepidemiologic Research (CEIFE), 28004 Madrid, SpainServicio de Aparato Digestivo, Hospital Clínico, University of Zaragoza, 50009 IIS Aragón, Zaragoza, SpainEpidemiology, Bayer AG, 13353 Berlin, GermanyEpidemiology, Bayer AG, 13353 Berlin, GermanySpanish Centre for Pharmacoepidemiologic Research (CEIFE), 28004 Madrid, SpainEstimates of the effect of proton pump inhibitors (PPIs) on risks of upper and lower gastrointestinal bleeding (UGIB and LGIB) among low-dose aspirin users in routine clinical practice are variable (UGIB) or lacking (LGIB). We aimed to establish these risks in the same observational study population. Using UK primary care data, we followed 199,049 new users of low-dose aspirin (75–300 mg/day) and matched non-users at start of follow-up to identify incident UGIB/LGIB cases. In nested case–control analyses, adjusted odds ratios (ORs) were calculated for concomitant PPI use vs. past (discontinued) PPI use among current low-dose aspirin users. For UGIB (<i>n</i> = 987), ORs (95% CIs) were 0.69 (0.54–0.88) for >1 month PPI use and 2.65 (1.62–4.3) for ≤1 month PPI use. Among the latter group, ORs (95% CIs) were 3.05 (1.75–5.33) for PPI initiation after start of aspirin therapy, and 1.66 (0.63–4.36) for PPI initiation on/before start of aspirin therapy. For LGIB (<i>n</i> = 1428), ORs (95% CIs) were 0.98 (0.81–1.17) for >1 month PPI use and 1.12 (0.73–1.71) for ≤1 month PPI use. Among low-dose aspirin users, maintaining PPI use (>1 month) was associated with a significantly reduced UGIB risk. Neither short nor long-term PPI use affected LGIB risk.https://www.mdpi.com/2077-0383/9/4/928aspirinproton pump inhibitorsupper gastrointestinal bleedinglower gastrointestinal bleeding |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Luis A. García Rodríguez Angel Lanas Montse Soriano-Gabarró Pareen Vora Lucía Cea Soriano |
spellingShingle |
Luis A. García Rodríguez Angel Lanas Montse Soriano-Gabarró Pareen Vora Lucía Cea Soriano Effect of Proton Pump Inhibitors on Risks of Upper and Lower Gastrointestinal Bleeding among Users of Low-Dose Aspirin: A Population-Based Observational Study Journal of Clinical Medicine aspirin proton pump inhibitors upper gastrointestinal bleeding lower gastrointestinal bleeding |
author_facet |
Luis A. García Rodríguez Angel Lanas Montse Soriano-Gabarró Pareen Vora Lucía Cea Soriano |
author_sort |
Luis A. García Rodríguez |
title |
Effect of Proton Pump Inhibitors on Risks of Upper and Lower Gastrointestinal Bleeding among Users of Low-Dose Aspirin: A Population-Based Observational Study |
title_short |
Effect of Proton Pump Inhibitors on Risks of Upper and Lower Gastrointestinal Bleeding among Users of Low-Dose Aspirin: A Population-Based Observational Study |
title_full |
Effect of Proton Pump Inhibitors on Risks of Upper and Lower Gastrointestinal Bleeding among Users of Low-Dose Aspirin: A Population-Based Observational Study |
title_fullStr |
Effect of Proton Pump Inhibitors on Risks of Upper and Lower Gastrointestinal Bleeding among Users of Low-Dose Aspirin: A Population-Based Observational Study |
title_full_unstemmed |
Effect of Proton Pump Inhibitors on Risks of Upper and Lower Gastrointestinal Bleeding among Users of Low-Dose Aspirin: A Population-Based Observational Study |
title_sort |
effect of proton pump inhibitors on risks of upper and lower gastrointestinal bleeding among users of low-dose aspirin: a population-based observational study |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2020-03-01 |
description |
Estimates of the effect of proton pump inhibitors (PPIs) on risks of upper and lower gastrointestinal bleeding (UGIB and LGIB) among low-dose aspirin users in routine clinical practice are variable (UGIB) or lacking (LGIB). We aimed to establish these risks in the same observational study population. Using UK primary care data, we followed 199,049 new users of low-dose aspirin (75–300 mg/day) and matched non-users at start of follow-up to identify incident UGIB/LGIB cases. In nested case–control analyses, adjusted odds ratios (ORs) were calculated for concomitant PPI use vs. past (discontinued) PPI use among current low-dose aspirin users. For UGIB (<i>n</i> = 987), ORs (95% CIs) were 0.69 (0.54–0.88) for >1 month PPI use and 2.65 (1.62–4.3) for ≤1 month PPI use. Among the latter group, ORs (95% CIs) were 3.05 (1.75–5.33) for PPI initiation after start of aspirin therapy, and 1.66 (0.63–4.36) for PPI initiation on/before start of aspirin therapy. For LGIB (<i>n</i> = 1428), ORs (95% CIs) were 0.98 (0.81–1.17) for >1 month PPI use and 1.12 (0.73–1.71) for ≤1 month PPI use. Among low-dose aspirin users, maintaining PPI use (>1 month) was associated with a significantly reduced UGIB risk. Neither short nor long-term PPI use affected LGIB risk. |
topic |
aspirin proton pump inhibitors upper gastrointestinal bleeding lower gastrointestinal bleeding |
url |
https://www.mdpi.com/2077-0383/9/4/928 |
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