Proton Pump Inhibitors in Preventing Recurrent Bleeding Among Patients Receiving Oral Anticoagulants With Upper Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

OBJECTIVES: The benefit of using the proton-pump inhibitors (PPIs) among patients on oral anticoagulants (OAC) with history of upper gastrointestinal bleeding (UGIB) is still limited. We conducted a systematic review and meta-analysis to estimate the benefit of PPIs in preventing recurrent bleeding among patients using OAC.

METHODS: A systematic search of PubMed, EMBASE, Cochrane and Scopus databases was performed for studies reporting recurrent UGIB in patients using OAC and PPIs co-therapy. Primary outcomes were hazard ratio (HR) in UGIB. Pooled estimates of UGIB risk were calculated by a random-effect meta-analysis and reported as HR and 95% confidence interval.

RESULTS: A total of 3 studies and 54,959 participants were included. OAC and PPI co-therapy were associated with a lower risk of recurrent UGIB with hazard ratio (95%CI) was 0.69 (0.56-0.82). In subgroup analysis, PPI co-therapy with vitamin K anticoagulant (VKA) and direct oral anticoagulants (DOAC), were associated with a lower risk of recurrent GI bleeding with a hazard ratio (95%CI) 0.67 (0.54-0.80) and 0.63 (0.47-0.79), respectively.

CONCLUSIONS: In patients with history of UGIB, OAC and PPI co-therapy showed the potential in lowering risk of UGIB. PPI co-therapy can be considered in patients using OAC with the history of UGIB.