Potential clinical benefits of proton pump inhibitors for secondary prevention of recurrent bleeding among patients with upper gastrointestinal bleeding receiving oral anticoagulants: a systematic review and meta-analysis

Objectives Proton pump inhibitors (PPIs) are commonly used among these patients to prevent upper gastrointestinal bleeding (UGIB) in anticoagulated patients. However, their clinical benefits among patients receiving OACs with a history of UGIB remain inconclusive. This study aimed to summarize the clinical benefits of PPIs for the secondary prevention of recurrent UGIB among patients using OACs. Methods A systematic search was performed in PubMed, EMBASE, Cochrane, and Scopus databases for clinical studies conducted among patients receiving OACs with PPIs and a history of UGIB. The primary outcome was the recurrent UGIB, analysed using a random-effect model. Heterogeneity was assessed by the I2-statistic. The quality of studies was assessed by the Newcastle-Ottawa Scale. Key findings and conclusions Four studies with a total of 67 148 participants were included. Of those, three were conducted among patients with atrial fibrillation and one among unspecified patients. Our meta-analysis indicated that PPIs were associated with a lower risk of recurrent UGIB with a hazard ratio (HR) of 0.67 (95%CI; 0.58–0.76, I2 = 8.9%) compared with no PPIs for patients receiving oral anticoagulants. Our subgroup analysis using comparators showed the robustness of the main findings. The HR of PPIs for recurrent UGIB in patients receiving vitamin K antagonists and direct oral anticoagulants compared with no PPI were 0.67 (95%CI; 0.54–0.80, I2 = 0.0%) and 0.63 (95%CI; 0.52–0.74, I2 = 0.0%), respectively. PPIs could potentially reduce the risk of recurrent UGIB. Clinicians might consider using PPIs for secondary prevention among patients receiving OAC.