Abstract：
BACKGROUND: To investigate risks of hospitalization for upper gastrointestinal bleeding (UGIB) in H. pylori-eradicated patients newly started on warfarin or direct oral anti-coagulants (DOACs).
METHODS: We identified all patients who had previously received H. pylori eradication therapy or were found to have no H. pylori on endoscopy and were then newly started on warfarin or DOACs from a population-based electronic healthcare database. Primary analysis was the risk of UGIB between warfarin and DOACs users in H. pylori-eradicated patients. Secondary analysis included the UGIB risk between H. pylori-eradicated and H. pylori-negative patients who were newly started on warfarin or DOACs. The hazard ratio (HR) of UGIB was approximated by pooled logistic regression model incorporating the inverse propensity of treatment weightings with time-varying covariables.
RESULTS: Among H. pylori-eradicated patients, DOACs had a significantly lower risk of UGIB (HR: 0.26, 95% CI 0.09-0.71) compared with warfarin. In particular, lower UGIB risks with DOACs were observed among older (≥65 years) patients, female, those without a history of UGIB or peptic ulcer, or ischemic heart disease, and non-users of acid-suppressive agents or aspirin. Secondary analysis showed no significant difference in UGIB risk between H. pylori-eradicated and H. pylori-negative patients newly started on warfarin (HR: 0.63,95% CI 0.33-1.19) or DOACs (HR: 1.37, 95% CI 0.45-4.22).
CONCLUSIONS: In H. pylori-eradicated patients, new users of DOACs had a significantly lower risk of UGIB than new warfarin users. Furthermore, the risk of UGIB in new warfarin or DOACs users was comparable between H. pylori-eradicated and H. pylori-negative patients.
METHODS: We identified all patients who had previously received H. pylori eradication therapy or were found to have no H. pylori on endoscopy and were then newly started on warfarin or DOACs from a population-based electronic healthcare database. Primary analysis was the risk of UGIB between warfarin and DOACs users in H. pylori-eradicated patients. Secondary analysis included the UGIB risk between H. pylori-eradicated and H. pylori-negative patients who were newly started on warfarin or DOACs. The hazard ratio (HR) of UGIB was approximated by pooled logistic regression model incorporating the inverse propensity of treatment weightings with time-varying covariables.
RESULTS: Among H. pylori-eradicated patients, DOACs had a significantly lower risk of UGIB (HR: 0.26, 95% CI 0.09-0.71) compared with warfarin. In particular, lower UGIB risks with DOACs were observed among older (≥65 years) patients, female, those without a history of UGIB or peptic ulcer, or ischemic heart disease, and non-users of acid-suppressive agents or aspirin. Secondary analysis showed no significant difference in UGIB risk between H. pylori-eradicated and H. pylori-negative patients newly started on warfarin (HR: 0.63,95% CI 0.33-1.19) or DOACs (HR: 1.37, 95% CI 0.45-4.22).
CONCLUSIONS: In H. pylori-eradicated patients, new users of DOACs had a significantly lower risk of UGIB than new warfarin users. Furthermore, the risk of UGIB in new warfarin or DOACs users was comparable between H. pylori-eradicated and H. pylori-negative patients.
摘要：
背景：本研究旨在调查幽门螺杆菌根除患者新开始接受华法林或直接口服抗凝剂（DOAC）治疗的上消化道出血（UGIB）住院风险。
方法：我们从基于人群的电子医疗数据库中确定了所有以前接受过幽门螺杆菌根除治疗或在内窥镜检查中发现没有幽门螺杆菌的患者，然后新开始接受华法林或DOAC治疗。主要分析是幽门螺杆菌根除患者华法林和DOACs使用者之间的UGIB风险。次要分析包括根除幽门螺杆菌和新开始服用华法林或DOAC的幽门螺杆菌阴性患者之间的UGIB风险。UGIB的风险比(HR)通过合并具有时变协变量的治疗权重的逆倾向的组合逻辑回归模型来近似。
结果：在根除幽门螺杆菌的患者中，与华法林相比，DOACs的UGIB风险明显降低（HR：0.26，95％CI0.09-0.71）。特别是,在老年（≥65岁）患者中观察到DOAC的UGIB风险较低，女性,那些没有UGIB或消化性溃疡病史的人，或者缺血性心脏病,和不使用酸抑制剂或阿司匹林。二次分析显示，根除幽门螺杆菌和新开始服用华法林（HR：0.63，95％CI0.33-1.19）或DOAC（HR：1.37，95％CI0.45-4.22）的幽门螺杆菌阴性患者之间的UGIB风险没有显着差异。
结论：在根除幽门螺杆菌的患者中，DOACs新使用者的UGIB风险显著低于华法林新使用者.此外，在根除幽门螺杆菌和幽门螺杆菌阴性患者中,新使用华法林或DOACs患者的UGIB风险相当.
方法：我们从基于人群的电子医疗数据库中确定了所有以前接受过幽门螺杆菌根除治疗或在内窥镜检查中发现没有幽门螺杆菌的患者，然后新开始接受华法林或DOAC治疗。主要分析是幽门螺杆菌根除患者华法林和DOACs使用者之间的UGIB风险。次要分析包括根除幽门螺杆菌和新开始服用华法林或DOAC的幽门螺杆菌阴性患者之间的UGIB风险。UGIB的风险比(HR)通过合并具有时变协变量的治疗权重的逆倾向的组合逻辑回归模型来近似。
结果：在根除幽门螺杆菌的患者中，与华法林相比，DOACs的UGIB风险明显降低（HR：0.26，95％CI0.09-0.71）。特别是,在老年（≥65岁）患者中观察到DOAC的UGIB风险较低，女性,那些没有UGIB或消化性溃疡病史的人，或者缺血性心脏病,和不使用酸抑制剂或阿司匹林。二次分析显示，根除幽门螺杆菌和新开始服用华法林（HR：0.63，95％CI0.33-1.19）或DOAC（HR：1.37，95％CI0.45-4.22）的幽门螺杆菌阴性患者之间的UGIB风险没有显着差异。
结论：在根除幽门螺杆菌的患者中，DOACs新使用者的UGIB风险显著低于华法林新使用者.此外，在根除幽门螺杆菌和幽门螺杆菌阴性患者中,新使用华法林或DOACs患者的UGIB风险相当.
