PPI Initiation in Patients Treated With Direct Oral Anticoagulants Examined

Patients treated with direct oral anticoagulants (DOACs) often initiate proton pump inhibitor (PPI) therapy, according to a population-based observational study published in the journal Pharmacoepidemiology & Drug Safety.

To investigate the association between DOAC use and PPI initiation, researchers used data from community pharmacies in the Netherlands from 2012-2016. Patients who initiated DOAC therapy for atrial fibrillation and were not taking PPIs were eligible for inclusion; the primary outcome measure of the study was subsequent PPI initiation.

Among the 28,553 DOAC users included in the analysis, 10,942 were treated with dabigatran, 4,897 were taking apixaban, and 12,714 were on rivaroxaban. Results showed that patients treated with apixaban and rivaroxaban had a similar risk of PPI initiation (adjusted hazard ratio [HR] 1.06; 95% CI 0.96, 1.31), however, for dabigatran users, the adjusted HR for starting PPI treatment was 1.21 (95% CI 1.14, 1.29), compared with rivaroxaban and apixaban. “The cumulative incidence of PPI initiation at 6 months of follow‐up for patients using dabigatran was 13.0%, and 10.0% for those using rivaroxaban/apixaban, yielding a number needing treatment of 33,” the study authors noted.

According to the findings of this study, PPI use for gastrointestinal complaints occurred frequently in patients treated with DOACs, but more often in those who received dabigatran.

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