Anticoagulant choice and proton pump inhibitor (PPI) co-therapy could affect risk of upper gastrointestinal bleeding, a frequent and potentially serious complication of oral anticoagulant treatment. A 2018 JAMA research publications concluded that the risk of hospitalization for upper gastrointestinal tract bleeding is highest with rivaroxaban and lowest with apixaban. For patients on anticoagulation, cotherapy with proton pump inhibitors seems to reduce the risk as well. Certain evidence corroborates/opposes these findings. Based on these findings, physicians should strongly consider proton proton pump inhibitor therapy for patients on anticoagulation and reconsider anticoagulation agents for patients at high risk for upper gastrointestinal bleeding.


1. Describe the 2018 JAMA research publication on the risk of upper gastrointestinal bleeding with anticoagulation therapy.
2. Explain the role of proton pump inhibitor cotherapy; highlighted by AAFP (2019) as research that can change primary care practice.
3. Present corroborating and opposing studies.
4. Explain the implications on clinical practice and recommend an approach for physician patient management based on these findings.

About the Speaker(s):

Seena Jose, MD

Seena Jose, MD
PGY-3 Resident
Department of Family and Community Medicine
UT Health San Antonio

Financial Disclosures:

Seena Jose, MD and her faculty mentor Maria Del Pilar Montañez Villacampa, MD have no relevant financial relationships with commercial interests to disclose.

The Family & Community Medicine Professional Development and Grand Rounds Committee members (Marcy Wiemers, MD, Maria Del Pilar Montañez Villacampa, MD, Christine Song, DO, Nehman Andry, MD, Inez I. Cruz, PhD, and Nichole Rubio) have no relevant financial relationships to commercial interests to disclose.

The Family & Community Medicine Professional Development and Grand Rounds Committee member Carlos Roberto Jaén, MD has disclosed he receives royalties from General Practice and Family Medicine for being UpToDate Editor-in-Chief.


AMA PRA Category 1 Credits™ (1.00 hours), Non-Physician Participation Credit (1.00 hours)

Target Audience:

Specialties – Primary Care; Family Medicine
Faculty, residents, other health care providers and staff from our department; physicians and health care providers from San Antonio and South Texas; and medical students in our third-year clerkship and fourth year rotations.


The UT Health Long San Antonio School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation:

The Long School of Medicine designates this live activity up to a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nurses and other healthcare professionals will receive a Certificate of Attendance. For information on applicability and acceptance, please consult your professional licensing board.

View Recording (CME Credit)

View Recording (no CME Credit)

For activity related questions, please contact:
Name: Nichole Rubio- FCM Grand Rounds Coordinator
Email: rubion@uthscsa.edu

For CME general questions, please contact
Ph: (210) 567-4445
Email: cme@uthscsa.edu