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We conducted a meta\u2010analysis to estimate the risk of GIB in patients with OAC and PPI cotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic search of PubMed, EMBASE, Cochrane and Scopus databases was performed for studies reporting GIB risk in OAC and PPI cotherapy. Primary outcomes were total GIB and major GIB events. Pooled estimates of GIB risk were calculated by a random\u2010effect meta\u2010analysis and reported as odds ratios and 95% confidence interval.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 10 studies and 1\u2009970\u2009931 patients were included. OAC and PPI cotherapy were associated with a lower odds of total and major GIB; odds ratio (95% confidence interval) was 0.67 (0.62\u20130.74) for total and 0.68 (0.63\u20130.75) for major GIB, respectively. No differences in the GIB of PPI cotherapy were observed between Asians and non\u2010Asians (<jats:italic>P<\/jats:italic>\u2010for\u2010difference, total GIB\u2009=\u2009.70, major GIB\u2009=\u2009.75, respectively). For all kinds of OAC except for edoxaban, PPI cotreatment was related to lower odds of GIB by 24\u201344%. The protective effect of PPI on total GIB was more significant in concurrent antiplatelets or nonsteroidal anti\u2010inflammatory drug users and those with high bleeding risks: patients with previous GIB history, HAS\u2010BLED \u22653 or underlying gastrointestinal diseases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In patients who receive OAC, PPI cotherapy is associated with a lower total and major GIB irrespective of ethnic group and OAC type, except for edoxaban. PPI cotherapy can be considered particularly in patients with high risk of GIB.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bcp.15478","type":"journal-article","created":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T16:30:21Z","timestamp":1659544221000},"page":"4676-4687","source":"Crossref","is-referenced-by-count":33,"title":["Protective effect of proton\u2010pump inhibitor against gastrointestinal bleeding in patients receiving oral anticoagulants: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"88","author":[{"given":"Hyo\u2010Jeong","family":"Ahn","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Seoul National University Hospital  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So\u2010Ryoung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Seoul National University Hospital  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0411-6372","authenticated-orcid":false,"given":"Eue\u2010Keun","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Seoul National University Hospital  Seoul Republic of Korea"},{"name":"Department of Internal Medicine Seoul National University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae\u2010Min","family":"Rhee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Seoul National University Hospital  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soonil","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Seoul National University Hospital  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seil","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Seoul National University Hospital  Seoul Republic of Korea"},{"name":"Department of Internal Medicine Seoul National University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y. 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