Association of Regular Antithrombotic Drug Use with the Risk of Non-Gallstone Acute Pancreatitis: A Prospective Cohort Study

BackgroundAntithrombotic drugs were widely used for cardiovascular disease prevention, but their association with nonbiliary acute pancreatitis remains unclear. AimThis study aimed to investigate the association between regular antithrombotic drug use and the risk of nonbiliary pancreatitis in the UK Biobank. MethodsThis prospective cohort study included 431,754 participants from the UK Biobank. Incident nonbiliary acute pancreatitis was identified through links to primary healthcare and hospitalization data. The Cox proportional hazards model estimated the relationship between antithrombotic drug use and nonbiliary acute pancreatitis risk. ResultsDuring a median follow-up period of 13.73 years, 2,189 nonbiliary acute pancreatitis cases were recorded. Antithrombotic users had a 31% higher risk of nonbiliary acute pancreatitis than non-users (HR = 1.31, 95% CI: 1.08 - 1.61, p = 0.007). Risk varied by specific agent: clopidogrel was associated with a 53% increased risk (HR = 1.53, 95% CI: 1.08 - 2.16, p = 0.016). For warfarin, the overall association was not statistically significant (HR = 1.32, 95% CI: 0.97 - 1.80, p = 0.076); however, subgroup analysis indicated that the association was confined to non-diabetic individuals (P-interaction = 0.015; HR = 1.64, 95% CI: 1.15 - 2.35, p = 0.007). No significant associations were observed for low-dose aspirin and dipyridamole. These results remained robust in sensitivity analyses, including propensity score matching analysis and lagging the exposure for one year. ConclusionsRegular use of antithrombotic drugs, especially clopidogrel, was associated with an increased risk of nonbiliary acute pancreatitis. The risk associated with warfarin was specific to non-diabetic individuals.