Key result
Among elderly Japanese patients with non-valvular atrial fibrillation, proton pump inhibitors were prescribed in 36.9% of patients, with the highest rate (53.5%) in those receiving both anticoagulants and antiplatelets.
Why the study?
The real-world status of proton pump inhibitor use in patients with atrial fibrillation receiving antithrombotic treatment was largely unknown.
Does proton pump inhibitor use correlate with specific clinical characteristics and antithrombotic regimens in elderly Japanese patients with non-valvular atrial fibrillation?
Observational (n=32,490)
Yes
Does proton pump inhibitor use correlate with specific clinical characteristics and antithrombotic regimens in elderly Japanese patients with non-valvular atrial fibrillation?
In elderly Japanese patients with non-valvular atrial fibrillation, proton pump inhibitors are frequently prescribed (36.9%), often without a documented gastrointestinal disorder, particularly in those receiving combined antithrombotic therapy.
PPI co-prescription is frequent with dual antithrombotics in elderly AF; leaves open whether routine use improves net outcomes without RCTs.
The real-world status of proton pump inhibitor (PPI) use in patients with atrial fibrillation (AF) receiving antithrombotic treatment is largely unknown. The All Nippon AF In the Elderly (ANAFIE) Registry, a prospective, multicenter, observational study, aimed to determine treatment patterns, risk factors, and outcomes among elderly (aged ≥75 years) Japanese non-valvular AF (NVAF) patients in the real-world clinical setting. The present subanalysis of the ANAFIE Registry determined the PPI prescription status of 32,490 elderly Japanese NVAF patients. Patients were stratified by PPI use (PPI+) or no PPI use (PPI-). Risk scores for stroke (CHADS2, CHA2DS2-VASc) and bleeding (HAS-BLED), anticoagulant use, time in therapeutic range (TTR) for warfarin, and anticoagulant/antiplatelet combination use were evaluated. PPIs were used in 11,981 (36.9%) patients. Compared with the PPI- group, the PPI+ group included a greater proportion of female patients (45.2% vs 41.3%; P <0.0001) and had significantly higher CHADS2, CHA2DS2-VASc, and HAS-BLED scores (P <0.0001 for each) as well as higher prevalences of several comorbidities. In the PPI+ group, 54.6% of patients did not have gastrointestinal (GI) disorders and were likely prescribed a PPI to prevent GI bleeding events. Most of the patients with a GI disorder in the PPI+ group had reflux esophagitis. Compared with patients not receiving anticoagulants, a significantly higher proportion of patients receiving anticoagulants received PPIs. For patients receiving anticoagulants, antiplatelet drugs, and both drugs, rates of PPI use were 34.1%, 44.1%, and 53.5%, respectively (P <0.01). Although the rate of PPI use was the highest for NVAF patients receiving both antiplatelet and anticoagulants, no clear differences were observed in the anticoagulants used. These data suggest that PPIs were actively prescribed in high-risk cases and may have been used to prevent GI bleeding among elderly NVAF patients receiving antithrombotic drugs. Trial registration: UMIN000024006.
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Mizokami et al. (2020) conducted an observational in Non-valvular atrial fibrillation (n=32,490). Proton pump inhibitor (PPI) use vs. No PPI use was evaluated on Proton pump inhibitor (PPI) prescription rate. Among elderly Japanese patients with non-valvular atrial fibrillation, proton pump inhibitors were prescribed in 36.9% of patients, with the highest rate (53.5%) in those receiving both anticoagulants and antiplatelets.
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