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Oral Anticoagulants, Proton Pump Inhibitors, and Fracture—Reply
JAMA Internal Medicine ( IF 39.0 ) Pub Date : 2020-04-01 , DOI: 10.1001/jamainternmed.2020.0271
Pamela L. Lutsey 1 , Faye L. Norby 1 , Alvaro Alonso 2
Affiliation  

In Reply We thank Uzoigwe and colleagues for their careful consideration of our article,1 which reported that among patients with atrial fibrillation (AF), fracture risk was lower among users of direct oral anticoagulants (DOACs), particularly apixaban, compared with users of warfarin. Uzoigwe and colleagues suggest an alternate explanation for our findings: that confounding by use of proton pump inhibitors (PPIs) may underlie the differences we observed. This hypothesis is intriguing, given the high prevalence of PPI prescriptions among older adults2,3 combined with evidence linking PPIs to fracture risk.4 We had not previously explicitly considered PPIs; however, confounding by PPI use should have been mitigated through our rigorous approach to minimize confounding, particularly via the use of high-dimensional propensity scores, which incorporated all available information on pharmacy prescription fills, inpatient and outpatient diagnostic codes, and inpatient and outpatient procedure codes.



中文翻译:

口服抗凝剂,质子泵抑制剂和骨折—回复

在答复中,我们感谢Uzoigwe及其同事对我们的文章进行了仔细的考虑1,该文章报道在房颤(AF)患者中,直接口服抗凝剂(DOAC)使用者(尤其是阿哌沙班)的骨折风险比华法林使用者低。Uzoigwe和同事为我们的发现提出了另一种解释:使用质子泵抑制剂(PPI)造成的混淆可能是我们观察到的差异的基础。这个假设是耐人寻味,因为PPI处方的老年人中的患病率高2 ,3有证据表明生产者价格指数骨折风险相结合。4我们以前没有明确考虑过PPI;但是,应该通过我们严格的方法来减少PPI的使用所造成的混淆,以最大程度地减少混淆,尤其是通过使用高维度倾向评分,该评分结合了有关药房处方填充,住院和门诊诊断代码以及住院和门诊程序的所有可用信息代码。

更新日期:2020-04-01
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