title: Proton pump inhibitors are associated with lower gastrointestinal tract bleeding in low-dose aspirin users with ischaemic heart disease.
abstract: BACKGROUND
  Impact of acid suppressants on lower gastrointestinal bleeding remains unclear in low-dose aspirin users; we aimed to investigate this relationship.
  
  
  METHODS
  Retrospective cohort study of low-dose aspirin users who underwent coronary angiography for ischaemic heart disease in our institution between October 2005 and December 2006; patients were evaluated for upper or lower gastrointestinal bleedings within 3 years post-angiography.
  
  
  RESULTS
  538 patients were enrolled (males, 74.4%; mean age 67.4±10.6 years). Risk for upper gastrointestinal bleeding decreased with concomitant use of statins (HR, 0.37; 95% CI, 0.15-0.89), calcium channel blockers (HR, 0.29; 95% CI, 0.10-0.85), and histamine-2 receptor antagonists (HR, 0.26; 95% CI, 0.08-0.89). Concomitant use of proton pump inhibitors tended to decrease risk of upper gastrointestinal bleeding (HR, 0.27; 95% CI, 0.06-1.18). Risk for lower gastrointestinal bleeding increased with both concomitant use of warfarin (HR, 15.68; 95% CI, 4.43-55.53) and proton pump inhibitors (HR, 6.55; 95% CI, 2.01-21.32), but not with histamine-2 receptor antagonists. Hyperuricemia lowered risk for lower gastrointestinal bleeding (HR, 0.12; 95% CI, 0.02-0.88).
  
  
  CONCLUSIONS
  In low-dose aspirin users, concomitant use of proton pump inhibitors increased lower gastrointestinal bleeding risk, independent from effects on upper gastrointestinal bleeding.
authors.affiliation: Department of Gastroenterology, Nippon Medical School, Tokyo, Japan. Electronic address: km366@nms.ac.jp.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Miyake
authors.affiliation: Department of Gastroenterology, Nippon Medical School, Tokyo, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Akimoto
authors.affiliation: Department of Gastroenterology, Nippon Medical School, Tokyo, Japan.
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Hanada
authors.affiliation: Department of Gastroenterology, Nippon Medical School, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nagoya
authors.affiliation: Department of Gastroenterology, Nippon Medical School, Tokyo, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodaka
authors.affiliation: Department of Gastroenterology, Nippon Medical School, Tokyo, Japan.
authors.forename: Nobue
authors.initials: N
authors.lastname: Ueki
authors.affiliation: Department of Gastroenterology, Nippon Medical School, Tokyo, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kusunoki
authors.affiliation: Department of Gastroenterology, Nippon Medical School, Tokyo, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kawagoe
authors.affiliation: Department of Gastroenterology, Nippon Medical School, Tokyo, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Futagami
authors.affiliation: Department of Cardiology, Nippon Medical School, Tokyo, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Cardiology, Nippon Medical School, Tokyo, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takano
authors.affiliation: Department of Gastroenterology, Nippon Medical School, Tokyo, Japan.
authors.forename: Choitsu
authors.initials: C
authors.lastname: Sakamoto
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016016:Proportional Hazards Models; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006635:Histamine H2 Antagonists; D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D001241:Aspirin
keywords: Gastrointestinal bleeding; Histamine-2 receptor antagonists; Low-dose aspirin; Oroton pump inhibitors