Abstract

 


Background and aim. Gastrointestinal bleeding (GIB) is one of the most common medical emergencies. Proton pump inhibitors (PPI) are among the most widely used drugs in gastroenterology to treat various types of acid-related disorders. We aim to investigate the safety of proton pump inhibitors (PPIs) when used concurrently with anticoagulants in patients with upper and lower gastrointestinal bleeding (GIB) and assess the risk of hospitalization, GIB, and mortality in patients receiving this combined treatment.


Methods. A retrospective multicenter study was conducted at two tertiary care hospitals. Patients were selected according to inclusion and exclusion criteria. Demographic data, vital signs, medical history, physical examinations, comorbid conditions, medications, laboratory investigations, endoscopy findings, management, and complications were retrieved from the medical records of all participants.


Data obtained from all patients’ medical records were reviewed. Endoscopic findings and management of the bleeding site were collected according to the presenting symptoms. Statistical analyses were performed using IBM SPSS version 25.0 software.


Results. Our results revealed a significant increase in acute GIB risk with the number of concurrent anticoagulants used, particularly in patients not using PPIs. Those using four anticoagulants along with PPIs had a lower likelihood of acute GIB at 6.3% (P = 0.0001). Patients taking two or three anticoagulants also experienced reduced GIB risk when PPIs were added (P ≤ 0.05). Age played a role, with a statistically significant difference between PPI users and non-users, especially in the 31-40 age group, where PPI users had a higher incidence of GIB (69.80%) compared to non-users (30.20%) (P < 0.05). Comparing patients on anticoagulants with or without PPIs, the study found a lower risk of hospitalization (adjusted hazard ratio, AHR: 1.02; 95% CI: 0.92-1.57) and mortality (AHR: 1.00; 95% CI: 0.84-1.11) in those using Rivaroxaban and PPIs concurrently. By contrast, patients using Rivaroxaban alone without PPIs faced an increased risk of hospitalization (AHR: 1.15; 95% CI: 0.98-2.35) and mortality (AHR: 1.12; 95% CI: 0.90-1.37).


Conclusions. Combining PPIs with anticoagulant drugs reduced the risk of GIB, hospitalization, and mortality, particularly in older adults, thereby mitigating potential complications.

Keywords

gastrointestinal bleeding, proton pump inhibitors, anticoagulants, geriatric, acid release