STUDY QUESTION: What is the effect of proton pump inhibitors (PPIs) on the risk of @entity360 in post- @entity583 patients taking antithrombotics and treated with non-steroidal anti-inflammatory drugs (NSAIDs)? METHODS: This was a nationwide cohort study based on linked administrative registry data from all hospitals in Denmark between 1997 and 2011. The study included @entity1 aged 30 years and over admitted with a first @entity583 who survived at least 30 days after discharge. The association between PPIs and risk of @entity360 according to NSAID plus antithrombotic therapy was estimated using adjusted time dependent Cox regression models. STUDY ANSWER AND LIMITATIONS: The use of PPIs was independently associated with decreased risk of @entity360 in post- @entity583 patients taking antithrombotics and treated with NSAIDs. Of 82,955 post- @entity583 @entity1 (mean age 67.4 years, 64% (n=53,070) @entity1 ), all of whom were taking single or dual antithrombotic therapy, 42.5% (n=35,233) filled at least one prescription for NSAIDs and 45.5% (n=37,771) received PPIs. Over a mean follow-up of 5.1 years, 3229 @entity360 occurred. The crude incidence rates of @entity548 (events/100 @entity1 years) on NSAID plus antithrombotic therapy were 1.8 for @entity1 taking PPIs and 2.1 for those not taking PPIs. The adjusted risk of @entity548 was lower with PPI use (hazard ratio 0.72, 95% confidence interval 0.54 to 0.95) regardless of antithrombotic treatment regimen, type of NSAID, and type of PPI used. The main limitation of the study is its observational non-randomised design. The results suggest that PPI treatment probably has a beneficial effect regardless of underlying gastrointestinal risk and that when NSAIDs cannot be avoided in post- @entity583 @entity1 , physicians might prescribe a PPI as well. The study does not clarify whether PPIs might be safely omitted in specific subgroups of @entity1 with a low risk of @entity360 . WHAT THIS STUDY ADDS: In post- @entity583 @entity1 , @entity548 complications have been associated with both antithrombotic and NSAID treatment. Concurrent use of PPIs was independently associated with a decreased risk of @entity360 in post- @entity583 patients taking antithrombotics and NSAID, regardless of antithrombotic treatment regimen, type of NSAID, and type of PPI used. FUNDING, COMPETING INTERESTS, DATA SHARING: AMSO has received a grant from the Danish Council of Independent Research (grant 12-132760). GHG is supported by an unrestricted research scholarship from the Novo Nordisk Foundation.

Impact of proton pump inhibitor treatment on @entity360 associated with non-steroidal anti-inflammatory drug use among post- XXXX patients taking antithrombotics: nationwide study.

@entity1 :: ('9606', 'Species') :: ['patients', 'person', 'men'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction'] @entity360 :: ('MESH:D006471', 'Disease') :: ['gastrointestinal bleeding', 'gastrointestinal bleeds'] @entity548 :: ('MESH:D006470', 'Disease') :: ['bleeding']
@entity583 :: (MESH:D009203,Disease) :: ['myocardial infarction']
