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| |  PPIs Cut Upper GI Bleeding Risk in Half During Antiplatelet Therapy: Presented at GASTRO 2009 (UEGW/WCOG) By Sara Freeman LONDON -- December 2, 2009 -- Treatment with proton pump inhibitors (PPIs) reduce the risk of upper gastrointestinal (GI) bleeding by 56% in hospitalised patients taking antiplatelet agents, according to results of a nested case-control study presented here at GASTRO 2009. “We compared the prevalence of PPI intake in patients who bled on antiplatelet therapy, and we compared the proportion of patients with upper and lower GI bleeding,” explained Jean-François Bretagne, PhD, Centre Hospitalier Universitaire de Rennes, Rennes, France, speaking in an exclusive interview with DocGuide here on November 23. Given that PPIs have no protective role against lower GI bleeding, Dr. Bretagne noted that the patients with lower GI bleeds were used as the control group. “We found a difference in both groups, in favour of protection with PPI for upper GI bleeding,” he said. The multicentre study was conducted at 80 hospitals in France, with 1,010 patients prospectively recruited at admission for GI bleeding, and 297 found to be taking antiplatelet agents -- 191 taking low-dose aspirin (LDA), 65 taking clopidogrel, and 41 taking both agents (dual antiplatelet therapy [DAT]). A total of 160 patients were admitted with upper GI bleeding and 127 with lower GI bleeding. The final matched study population included 121 patients with upper GI bleeding (cases) and 121 patients with lower GI bleeding (controls). The mean age of patients in both groups was 78 years, with 15.7% of patients having a history of gastric or duodenal ulcer. LDA was the predominant form of antiplatelet therapy used -- 79% of cases and 75% of controls -- with clopidogrel used in 21% and 31%, and DAT in 21% and 15% of patients, respectively. One quarter of cases and 43.8% of controls were using PPIs (P = .003). The main causes of bleeding in control subjects (upper GI bleeding) were gastric ulcer (28.9%), duodenal ulcer (26.7%), other (19.6%), oesophagitis (14.9%), and erosive gastritis (9.9%). In comparison, the main causes of bleeding in control subjects (lower GI bleeding) were diverticulosis (40.5%), other (28.1%), colorectal neoplasia (15.7%), ischaemic colitis (9.1%), and angiodysplasia (6.6%). Dr. Bretagne and colleagues reported that the risk of upper GI bleeding was lower in patients who were treated with PPIs than in those who were not (26.0% or 39.5% of cases and 44.8% or 55.8% of controls, depending on the definition used for the risk of upper GI bleeding). “This … shows that PPI therapy significantly reduced the risk of upper GI bleeding,” the researchers concluded. They added that the study also showed insufficient use of routine gastroprotection in patients with other GI risk factors in addition to antiplatelet therapy. Funding for this study was provided by AstraZeneca. GASTRO 2009 is jointly organised by the United European Gastroenterology Federation (UEGF), the World Gastroenterology Organisation (WGO), the World Organisation of Digestive Endoscopy (OMED), and the British Society of Gastroenterology (BSG). [Presentation title: Prevention by Proton Pump Inhibitors (PPI) of Upper Gastrointestinal Bleeding Associated With Antiplatelet Therapy Results of a Nested Case-Control Study. Abstract P003]
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