Does Helicobacter pylori treatment reduce recurrence of upper gastrointestinal bleeding in patients with atrial fibrillation on antithrombotic drugs?

Aims Gastrointestinal bleeding (GIB) is a serious and potentially life-threatening complication that frequently occurs in patients taking antithrombotic therapy, including those with chronic diseases such as atrial fibrillation (AF). While previous studies have reported the effect of HP eradication on GIB in participants taking aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), its effect on GIB in AF patients taking anticoagulants is not well established.

The risk of recurrent gastrointestinal bleeding (GIB) in atrial fibrillation (AF) patients on anti-thrombotic after H. pylori (HP) eradication remains poorly defined.

To our knowledge, there has been no randomized controlled trial on this subject, and there is a lack of large-scale cohort studies utilizing insurance claim big data to assess the effectiveness of HP treatment in preventing rebleeding in antithrombotic-related ulcer bleeding. Therefore, there is a significant unmet need for further investigation into this important clinical issue.

The aim of this study is to assess the impact of HP treatment on the risk of recurrent GIB in AF patients with previous antithrombotic-related GIB, based on nationwide health insurance claim data.

Methods We characterized the incidences of hospitalizations for all recurrent GIB in antithrombotic users according to HP eradication therapy. Based on the nationwide claims and health database, we identified all AF patients newly diagnosed with upper GIB between 2010 and 2017. Patients were divided into three cohorts according to the anti-thrombotic use after AF diagnosis: warfarin, NOAC, and anti- platelets. The primary outcome was incident rebleeding after index GIB during follow-up.

Results Among 250,666 AF patients first receiving NOACs or warfarin or antiplatelet from January 1, 2013 to December 31, 2018 in the overall cohort.

Among a total of 2670 AF patients with upper GIB, the warfarin group (94 pairs), NOAC group (98 pairs), and anti-platelet group (218 pairs) were compared for recurrent GIB after propensity matching for the treatment of HP. During 5 years follow-up, HP treatment was closely related to recurrent GIB with marginal trend toward significance in warfarin group (hazard ratio [HR] 0.77, 95% CI 0.51- 1.18) and anti-platelet group (HR 0.89, 95% CI 0.72-1.09). Whereas, HP treatments were independently related with a lower risk of all-cause mortality in the warfarin group (HR 0.28, 95% CI 0.09-0.87) and anti-platelet group (HR 0.79, 95% CI 0.67-0.93). [1] [2] [3]

Conclusions AF patients with GIB were not significantly associated with a lower risk for recurrent GIB after HP treatment, irrespective of the kinds of anti-thrombotic taken. However, for AF patients on anti-platelet, HP treatment reduced the risk of all-cause mortality during 5-years follow-up.

Publikationsverlauf

Artikel online veröffentlicht:
15. April 2024

• References

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• 2 Hawkey C, Avery A, Coupland CAC, Crooks C, Dumbleton J, Hobbs FDR, Kendrick D, Moore M, Morris C, Rubin G, Smith M, Stevenson D. HEAT Trialists. Helicobacter pylori eradication for primary prevention of peptic ulcer bleeding in older patients prescribed aspirin in primary care (HEAT): a randomised, double-blind, placebo-controlled trial. Lancet. 2022; 400 10363: 1597-1606
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