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

Table 4 Effect of protective agent uses on significant hemoglobin drop incidences for aspirin or clopidogrel alone users in self-controlled case series analyses

Exposure period	Aspirin-alone users (n = 351)		Clopidogrel-alone users (n = 35)		Concurrent users of aspirin & clopidogrel (n = 30)		Concomitant users of aspirin & clopidogrel (n = 348)
	IRR (95%CI)	P value	IRR (95%CI)	P value	IRR (95%CI)	P value	IRR (95%CI)	P value
All SHD events
Mucosal DA alone	Reference		Reference
PPI	0.33 (0.21-0.52)	< 0.001	0.43 (0.09-2.13)	0.301	0.39 (0.10-1.60)	0.191	0.43 (0.30-0.62)	< 0.001
PPI & rebamipide	0.35 (0.06-1.90)	0.223
PPI & H2RA							0.54 (0.18-1.64)	0.281
PPI & others							0.14 (0.02-1.02)	0.052
Rebamipide	0.69 (0.36-1.34)	0.276	0.25 (0.02-2.87)	0.263			1.49 (0.87-2.57)	0.148
Rebamipide & H2RA	0.61 (0.12-3.17)	0.553					0.27 (0.05-1.35)	0.111
H2RA	0.60 (0.43-0.83)	0.002	1.85 (0.55-6.23)	0.322	1.02 (0.42-2.53)	0.958	0.93 (0.67-1.29)	0.661
H2RA & others	0.46 (0.07-2.95)	0.411
Others	0.47 (0.20-1.10)	0.081	2.34 (0.32-17.19)	0.403			0.40 (0.15-1.07)	0.068
First SHD event only
Mucosal DA alone	Reference		Reference
PPI	0.33 (0.21-0.51)	< 0.001	0.42 (0.08-2.08)	0.286	0.39 (0.10-1.60)	0.191	0.45 (0.31-0.65)	< 0.001
PPI & rebamipide	0.35 (0.06-1.91)	0.224
PPI & H2RA							0.81 (0.26-2.50)	0.708
PPI & others							0.15 (0.02-1.04)	0.055
Rebamipide	0.74 (0.38-1.44)	0.380	0.26 (0.02-3.07)	0.285			1.46 (0.85-2.52)	0.173
Rebamipide & H2RA	0.60 (0.12-3.15)	0.549
H2RA	0.62 (0.44-0.86)	< 0.001	2.22 (0.59-8.33)	0.239	1.02 (0.42-2.53)	0.958	0.96 (0.69-1.34)	0.814
H2RA & others	0.45 (0.07-2.89)	0.401
Others	0.48 (0.20-1.12)	0.090	2.30 (0.31-16.93)	0.413

SHD: Significant hemoglobin drop; IRR: Incidence rate ratio; CI: Confidence interval; DA: Damaging agent; PPI: Proton pump inhibitor; H2RA: H2-receptor antagonist; Others: Agents such as sodium alginate, ecabet sodium hydrate, polaprezinc, and stillen (an ethanol extract of Artemisiae Argyi herba).