Acid Suppressants Reduce Risk of Gastrointestinal Bleeding in Patients on Antithrombotic or Anti-Inflammatory Therapy

BACKGROUND & AIMS: We investigated the effect of different prevention strategies against upper gastrointestinal bleeding (UGIB) in the general population and in patients on antithrombotic or anti-inflammatory treatments. METHODS: We performed a population-based, nested, case-control study using The Health Improvement Network UK primary care database. From 2000 to 2007, we identified 2049 cases of UGIB and 20,000 controls. The relative risk (RR) of UGIB associated with various gastroprotective agents was estimated by comparing current use (defined as use within 30 days of the index date) with nonuse in the previous year, using multivariate logistic regression. RESULTS: The adjusted RR of UGIB associated with current use of proton pump inhibitors (PPIs) for more than 1 month was 0.58 (95% confidence interval [CI], 0.42-0.79) among patients who received low-dose acetylsalicylic acid (ASA), 0.18 (95% CI, 0.04-0.79) for clopidogrel, 0.17 (95% CI, 0.04-0.76) for dual antiplatelet therapy, 0.48 (95% CI, 0.22-1.04) for warfarin, and 0.51 (95% CI, 0.34-0.78) for nonsteroidal anti-inflammatory drugs. The corresponding estimates for therapy with histamine-2-receptor antagonists (H2RAs) were more unstable, but tended to be of a smaller magnitude. In the general population, PPI use was associated with a reduced risk of UGIB compared with nonuse (RR, 0.80; 95% CI, 0.68-0.94); no such reduction was observed for H2RAs or nitrates. CONCLUSIONS: PPI use was associated with a lower risk of UGIB in the general population and in patients on antithrombotic or anti-inflammatory therapy compared with nonuse of PPIs. The reduction in risks of UGIB was smaller in H(2)RA than in PPI users.