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\begin{document}

\title{Concomitant direct oral anticoagulant and proton pump inhibitor use in
patients with atrial fibrillation}



\author[1]{Sarah Marston}%
\author[1]{Luke Bereznicki}%
\author[1]{woldesellassie bezabhe}%
\affil[1]{University of Tasmania}%


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  \date{May 20, 2024}


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\begin{abstract}
Background Co-prescribing a proton pump inhibitor (PPI) with an
anticoagulant, in patients with atrial fibrillation (AF) at high risk of
bleeding, decreases the risk of gastrointestinal bleeding. This study
aimed to identify Australian prescribing trends for this topic to inform
practice in this area. Methods This was a retrospective cohort study in
which a cross-sectional analysis of general practice data obtained from
MedicineInsight was performed, to evaluate current Australian
prescribing trends of PPIs in patients with AF. Patients aged 18 years
or more initiated on an oral anticoagulant between January 1st, 2011 and
April 25th, 2019 were included. Results A total of 28,863 participants
were included; of these, 5,092 (17.6\%) received PPI co-therapy. There
were 4,211 (14.6\%) participants at high risk of bleeding, with 878
(20.9\%) of these receiving PPI co-therapy. Participants were
significantly more likely to be prescribed a PPI if prescribed
dabigatran (adjusted odds ratio (AOR) 1.42 {[}1.28-1.57{]}, 95\%
confidence interval (CI)), apixaban (AOR 1.36 {[}1.26-1.46{]}, 95\%CI)
or rivaroxaban (AOR 1.28 {[}1.18-1.38{]}, 95\%CI) compared to warfarin.
Factors associated with PPI prescribing included, antiplatelet
co-therapy (AOR 2.09 {[}1.82-2.39{]}, 95\% CI), high CHA2DS2-VASc score
([?]2 male or [?]3 female) (AOR 1.50 {[}1.28-1.77{]}, 95\% CI) and a low
ORBIT score (\textless{}3) (AOR 1.42 {[}1.23-1.64{]}, 95\% CI).
Conclusion In this large nationally representative cohort, only 20.9\%
of participants who were at high risk of bleeding were co-prescribed a
PPI. Further research is required to investigate whether increased
prescribing of PPIs could improve patient outcomes. Key words: Atrial
fibrillation, proton pump inhibitors%
\end{abstract}%



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\textbf{Hosted file}

\verb`BJCP manuscript Sarah Marston.docx`  available at \url{https://authorea.com/users/735468/articles/711790-concomitant-direct-oral-anticoagulant-and-proton-pump-inhibitor-use-in-patients-with-atrial-fibrillation}

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