Evidence map›Paper›PMID 27639805›Full record

ArticleGastroenterology2016

Association of Proton Pump Inhibitors With Reduced Risk of Warfarin-Related Serious Upper Gastrointestinal Bleeding.

Wayne A Ray, Cecilia P Chung, Katherine T Murray, Walter E Smalley, James R Daugherty, William D Dupont, C Michael Stein

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Gastroenterology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
45citing papers in PubMed, 7 pooled it
6.7field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

45 citing papers in PubMed, 7 syntheses or guidelines pooled it, 112 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Guideline
  4. [Clinical Guidelines for Drug-induced Peptic Ulcer, 2020 Revised Edition].The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi · 2020
    Guideline
  5. Pooled it
  6. Pooled it
  7. Guideline
  8. Trial
  9. Trial
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Review
  16. Article
  17. Review
  18. Review
  19. Review
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Wayne A RayDepartment of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee. Electronic address: wayne.ray@vanderbilt.edu.
Cecilia P ChungDepartment of Medicine, Division of Rheumatology, Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee; Veterans' Administration Tennessee Valley Health Care System, Nashville, Tennessee.
Katherine T MurrayDepartment of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Medicine, Division of Cardiology, Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee.
Walter E SmalleyDepartment of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee; Veterans' Administration Tennessee Valley Health Care System, Nashville, Tennessee; Department of Gastroenterology, Vanderbilt University School of Medicine, Nashville, Tennessee.
James R DaughertyDepartment of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.
William D DupontDepartment of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
C Michael SteinDepartment of Medicine, Division of Rheumatology, Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee.
Vanderbilt University · US

Funding

Preventing Gastroduodenal Bleeding in Oral Anticoagulant UsersR01HL114518 · NHLBI · VANDERBILT UNIVERSITY MEDICAL CENTER · PI RAY, WAYNE A · 2013 to 2016
$2.0M
Drug-Drug Interactions and Preventable Adverse Events in RheumatologyK23AR064768 · NIAMS · VANDERBILT UNIVERSITY MEDICAL CENTER · PI CHUNG, CECILIA PILAR · 2013 to 2016
$531k
NHLBI NIH HHS R01 HL114518NIAMS NIH HHS K23 AR064768
6 · The paper itself

Abstract

BACKGROUND &

aimsProton pump inhibitors (PPIs) might reduce the risk of serious warfarin-related upper gastrointestinal bleeding, but the evidence of their efficacy for this indication is limited. A gastroprotective effect of PPIs would be particularly important for patients who take warfarin with antiplatelet drugs or nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), which further increase the risk of gastrointestinal bleeding.

methodsThis retrospective cohort study of patients beginning warfarin treatment in Tennessee Medicaid and the 5% National Medicare Sample identified 97,430 new episodes of warfarin treatment with 75,720 person-years of follow-up. The study end points were hospitalizations for upper gastrointestinal bleeding potentially preventable by PPIs and for bleeding at other sites.

resultsPatients who took warfarin without PPI co-therapy had 119 hospitalizations for upper gastrointestinal bleeding per 10,000 person-years of treatment. The risk decreased by 24% among patients who received PPI co-therapy (adjusted hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.63-0.91). There was no significant reduction in the risk of other gastrointestinal bleeding hospitalizations (HR, 1.07; 95% CI, 0.94-1.22) or non-gastrointestinal bleeding hospitalizations (HR, 0.98; 95% CI, 0.84-1.15) in this group. Among patients concurrently using antiplatelet drugs or NSAIDs, those without PPI co-therapy had 284 upper gastrointestinal bleeding hospitalizations per 10,000 person-years of warfarin treatment. The risk decreased by 45% (HR, 0.55; 95% CI, 0.39-0.77) with PPI co-therapy. PPI co-therapy had no significant protective effect for warfarin patients not using antiplatelet drugs or NSAIDs (HR, 0.86; 95% CI, 0.70-1.06). Findings were similar in both study populations.

conclusionsIn an analysis of patients beginning warfarin treatment in Tennessee Medicaid and the 5% National Medicare Sample, PPI co-therapy was associated with reduced risk of warfarin-related upper gastrointestinal bleeding; the greatest reduction occurred in patients also taking antiplatelet drugs or NSAIDs.

Indexed as

AgedAnticoagulantsAnti-Inflammatory Agents, Non-SteroidalDrug Therapy, CombinationFemaleGastrointestinal HemorrhageHospitalizationHumansMaleMedicaidMedicarePlatelet Aggregation InhibitorsProtective FactorsProton Pump InhibitorsRetrospective StudiesTennesseeAnticoagulantsAnti-Inflammatory Agents, Non-SteroidalPlatelet Aggregation InhibitorsProton Pump InhibitorsWarfarinAntiplatelet DrugsProton-Pump InhibitorWarfarin

Identifiers

PMID27639805
PMCPMC5124401
OpenAlexW2519773498

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.