Proton Pump Inhibitor Use and Clinical Outcomes in Atrial Fibrillation During Anticoagulation

Area of Science:

• Cardiology
• Pharmacology
• Clinical Research

Background:

• Proton pump inhibitors (PPIs) are frequently prescribed with oral anticoagulants (OACs) for atrial fibrillation (AF) patients.
• Evidence on PPIs' impact on non-gastrointestinal bleeding and thromboembolic events in AF patients is limited.

Purpose of the Study:

• To investigate the association between concomitant PPI use and thromboembolic events, bleeding outcomes, and all-cause mortality in AF patients on OACs.
• To evaluate risks beyond upper gastrointestinal bleeding associated with PPI use in this population.

Main Methods:

• Retrospective multicenter cohort study of 11,203 AF patients initiating OAC therapy.
• Time-varying PPI exposure modeled with a 7-day lag.
• Time-dependent Cox proportional hazard models used to estimate associations.

Main Results:

• PPI use was linked to increased risk of a composite outcome (HR 1.29), major bleeding (HR 1.80), gastrointestinal bleeding (HR 1.77), and all-cause mortality (HR 1.58).
• No significant association found between PPI use and thromboembolic events.
• Robustness analyses generally supported the observed associations, with variations based on exposure timing.

Conclusions:

• Concomitant PPI use in AF patients on OACs is associated with elevated risks of bleeding and all-cause mortality.
• The study did not find an association between PPI use and thromboembolic events.
• Findings highlight potential risks of PPIs beyond GI protection in anticoagulated AF patients, emphasizing observational nature of associations.