Current status of proton pump inhibitor use in Japanese elderly patients with non-valvular atrial fibrillation: A subanalysis of the ANAFIE Registry.

Yuji Mizokami,Satoshi Teramukai,Wataru Shimizu,Hiroyuki Tsutsui,Takatsugu Yamamoto,Atsushi Takita,Ken Okumura,Yukihiro Koretsune,Jumpei Kaburagi,Hiroshi Inoue,Takeshi Yamashita,Hirotsugu Atarashi,Takenori Yamaguchi,Masahiro Yasaka,Takanori Ikeda,Atsushi Hirayama,Masaharu Akao,Kazunori Toyoda,Tetsuya Kimura

doi:10.1371/journal.pone.0240859

Abstract

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

Highlights

Atrial fibrillation (AF) is a leading cause of morbidity and mortality [1, 2] and is an important risk factor for stroke [3, 4]
Of the total All Nippon AF In the Elderly (ANAFIE) population of 32,726 patients, 32,490 were included in the present analyses; 236 (0.7%) patients were excluded as their pump inhibitor (PPI) status was unknown
Significant differences were noted in the mean age and weight between the PPI+ group and PPI− group

Summary

Introduction

Atrial fibrillation (AF) is a leading cause of morbidity and mortality [1, 2] and is an important risk factor for stroke [3, 4]. As the prevalence of non-valvular AF (NVAF) increases with age [9], appropriate anticoagulation is important among the elderly, as this group is at the greatest risk of stroke attributable to AF [3, 10] and of bleeding [11, 12]. Clinicians must consider both the benefits and risks before prescribing an anticoagulant, as such therapy may increase the risk of bleeding [13, 14]. GI bleeding often leads to treatment discontinuation, which may, in turn, result in increased risks of thromboembolism and mortality [17, 18]

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Conclusion