The findings of a study revealed that concomitant therapy with a proton pump inhibitor (PPI) in non-vitamin K antagonist oral anticoagulants (NOAC)-treated patients with atrial fibrillation is linked with decreased risk of severe upper gastrointestinal bleeding (UGIB). Joris Komen et al. performed this population-based cohort study to assess if PPI therapy reduces UGIB risk in people with atrial fibrillation treated with NOACs.

In this, a common protocol, common data model approach was used, and the major endpoint was severe UGIB reported in a secondary care inpatient setting. For calculating the incidence rate ratios (IRRs), contrasting PPI use to no PPI use periods, an inverse probability weighted Poisson regression was utilized.

Out of 1, 64, 290 NOAC users having atrial fibrillation, with 2, 72,570 years of follow-up and 39 938 years of exposure to PPI, about 806 people had UGIB. As found, PPI usage was linked with reduced UGIB rates (IRR: 0.75). The protective effect was modest, and was reported to be largest in elevated-risk people with HAS-BLED score ≥3 (number needed to treat for one year [NNTY]: 378), age 75-84 years (NNTY: 787), receiving concomitant antiplatelet agents (NNTY: 373), or age ≥85 years (NNTY: 667).

Hence, PPI co-therapy has a protective effect and can be considered, particularly among elderly people, people with a HAS-BLED score of ≥3, and/or in people on concomitant antiplatelet therapy.