Protective effect of proton pump inhibitor against gastrointestinal bleeding in patients receiving oral anticoagulants: a systematic review and meta-analysis

Abstract Background The concurrent use of proton pump inhibitor (PPI) in oral anticoagulant (OAC) treated patients may be associated with a lower risk gastrointestinal bleeding (GIB), but evidence is still conflicting according to individual OACs. Purpose We conducted meta-analysis estimate the GIB OAC and PPI co-therapy. Methods A systematic search PubMed, EMBASE, Cochrane was performed for studies reporting Primary outcomes were total major events. calculated pooled estimates by random-effect reported as odds ratios (OR) 95% CI. Stratified analyses origin GIB, ethnic groups, OACs, presence underlying factors performed. Results 10 (1 randomized controlled study 9 observational studies) 1,970,931 who received included. co-therapy GIB; OR (95% CI) 0.67 (0.62–0.74) 0.68 (0.63–0.75) respectively. Among only upper (OR 0.67, CI 0.64–0.70). No difference primary observed between Asians non-Asians (p-for-difference, GIB=0.695, GIB=0.748, respectively) among OACs except edoxaban. protective effect on more significant high-risk patients, defined those medication antiplatelets or non-steroidal anti-inflammatory drugs 0.62, 0.52–0.73) high such previous history, HAS-BLED score ≥3, diseases. 0.65, 0.61–0.70). Conclusion In receive OAC, irrespective group type can considered particularly concomitant NSAID antiplatelet factors. Funding Acknowledgement Type funding sources: None.