Optimal strategies for mitigating gastrointestinal bleeding in patients receiving antiplatelet therapy: Real-world study

Table 3 Effect of protective agent uses on significant hemoglobin drop incidences by risk groups for all antiplatelet ± anticoagulant/non-steroidal anti-inflammatory drug patients in self-controlled case series analyses

Exposure period	Total (n = 1137)			High-risk group (n = 1028)			Low-risk group (n = 109)
	Number of SHD incidence	IRR (95%CI)	P value	Number of SHD incidence	IRR (95%CI)	P value	Number of SHD incidence	IRR (95%CI)	P value
All SHD events
Mucosal DA alone	939	Reference		845	Reference		94	Reference
PPI	233	0.42 (0.34-0.53)	< 0.001	222	0.42 (0.33-0.53)	< 0.001	11	0.46 (0.18-1.20)	0.114
PPI & rebamipide	2	0.07 (0.02-0.30)	< 0.001	2	0.07 (0.02-0.29)	< 0.001	0
PPI & H2RA	8	0.27 (0.11-0.65)	0.003	8	0.28 (0.12-0.68)	0.005	0
PPI & others	4	0.09 (0.02-0.52)	0.007	4	0.09 (0.01-0.51)	0.007	0
Rebamipide	122	0.68 (0.50-0.93)	0.017	110	0.66 (0.47-0.92)	0.014	12	0.92 (0.39-2.15)	0.840
Rebamipide & H2RA	6	0.23 (0.09-0.59)	0.002	6	0.25 (0.10-0.64)	0.004	0
H2RA	356	0.75 (0.63-0.90)	0.002	333	0.77 (0.64-0.93)	0.006	23	0.59 (0.31-1.13)	0.113
H2RA & others	2	0.24 (0.05-1.18)	0.078	2	0.34 (0.07-1.74)	0.196	0
Others	29	0.37 (0.22-0.60)	< 0.001	23	0.31 (0.17-0.53)	< 0.001	6	1.01 (0.27-3.79)	0.985
First SHD event only
Mucosal DA alone	938	Reference		844	Reference		94	Reference
PPI	219	0.43 (0.34-0.53)	< 0.001	208	0.42 (0.34-0.54)	< 0.001	11	0.43 (0.16-1.13)	0.087
PPI & rebamipide	2	0.07 (0.02-0.29)	< 0.001	2	0.07 (0.02-0.28)	< 0.001	0
PPI & H2RA	8	0.32 (0.13-0.78)	0.0120	8	0.34 (0.14-0.83)	0.017	0
PPI & others	4	0.09 (0.02-0.53)	0.0080	4	0.09 (0.02-0.53)	0.008	0
Rebamipide	118	0.68 (0.49-0.94)	0.0200	106	0.65 (0.46-0.92)	0.015	12	0.96 (0.40-2.28)	0.923
Rebamipide & H2RA	4	0.19 (0.06-0.55)	0.0020	4	0.20 (0.07-0.61)	0.005	0
H2RA	331	0.76 (0.63-0.91)	0.0030	309	0.78 (0.64-0.94)	0.010	22	0.60 (0.32-1.15)	0.122
H2RA & others	2	0.29 (0.06-1.45)	0.1300	2	0.43 (0.08-2.31)	0.328	0
Others	29	0.39 (0.24-0.65)	< 0.001	23	0.33 (0.19-0.58)	< 0.001	6	0.92 (0.24-3.49)	0.898

Adjusted incidence rate ratios were estimated after adjusting prescription period for protective agents and damaging agents. SHD: Significant hemoglobin drop; CI: Confidence interval; DA: Damaging agent; PPI: Proton pump inhibitor; H2RA: H2-receptor antagonist; IRR: Incidence rate ratio; Others: Agents such as sodium alginate, ecabet sodium hydrate, polaprezinc, and stillen (an ethanol extract of Artemisiae Argyi herba).