Why the study?
Long-term dabigatran increases upper GI bleeding risk, and while coadministered PPIs reduce this risk, debate persists regarding PPI-dabigatran interactions that decrease dabigatran plasma levels.
Does coadministration of proton pump inhibitors reduce upper gastrointestinal bleeding or decrease dabigatran plasma levels in patients with atrial fibrillation on long-term dabigatran therapy?
Does coadministration of proton pump inhibitors reduce upper gastrointestinal bleeding or decrease dabigatran plasma levels in patients with atrial fibrillation on long-term dabigatran therapy?
While PPIs reduce the risk of upper GI bleeding in patients on long-term dabigatran, clinicians must be aware of potential interactions that decrease dabigatran plasma levels.
May warrant PPI consideration to mitigate GI bleeding with dabigatran; leaves open net benefit amid possible plasma level reductions.
Dabigatran etexilate, a direct thrombin inhibitor, is now frequently used for long-term pharmacological prevention of stroke or systemic embolism in patients with atrial fibrillation. However, such long-term dabigatran therapy (DT) significantly increases the risk of upper gastrointestinal (GI) bleeding. This increased risk of gastric bleeds might be reduced with gastroprotective agents, such as proton pump inhibitors (PPIs). PPIs coadministrated with dabigatran reduce the risk of upper GI bleeding in patients on long-term oral DT. Nevertheless, there is heated discussion regarding interactions between PPI and dabigatran that lead to decreases in dabigatran plasma levels. This article reviews up to date data about the risk of gastric bleeding on dabigatran, the impact of PPI on the reduction of gastric bleeding, and the interaction between PPI and dabigatran leading to decreased dabigatran plasma levels.
No takes yet. Share an insight, caveat, or question.
Bolek et al. (2019) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: