Introduction Warfarin is an oral anticoagulant that requires ongoing monitoring with time in therapeutic range (TTR), a common measure of the quality of warfarin control and likelihood of adverse events including bleeds. Numerous factors can influence these warfarin outcomes including drug interactions. Proton pump inhibitors (PPIs) have been reported to interact with warfarin but there remain conflicting reports with regard to the impact on bleeds and limited data on TTR. Therefore, the aim of this study was to determine the effect of PPIs on warfarin control using TTR and bleeds as endpoints. Methods Retrospective data were collected for patients managed by a warfarin management clinic in Queensland. Data collected included current medications, reported bleeds and INR results to calculate TTR. Patients were grouped as taking PPIs or not taking PPIs. Analysis of TTR and bleeds occurred for these groups both before and after exclusions of other medication reported to interact with warfarin. Results Of the 4494 included patients, almost half (44.5%) were taking PPIs with esomeprazole most commonly (34.8%) prescribed. Patients taking PPIs had significantly reduced TTR compared with patients not taking PPIs both before (78.5 ± 9.7% vs 81.7 ± 10.2%, P < 0.0001) and after (84.4 ± 5.1% vs 89.4 ± 8.0%, P < 0.0001) excluding all other interacting medications with warfarin. Patients taking PPIs also had significantly higher incidence of minor bleeds compared with patients not taking PPIs (32.4% vs 26.1%, P = 0.0487). Discussion Patients taking PPIs with warfarin had significantly lower TTRs and higher incidence of minor bleeds. This combination warrants additional caution and monitoring with warfarin control as measured by TTR potentially affected.

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This study expanded the communicative ecology model of successful aging (CEMSA) to include communication about religion. Older adults ( N = 272, MAge = 64.96 years) reported on the most important memorable message about religion that has shaped their lives, as well as on their own religious communication (i.e., religious helping and seeking religious support). Memorable messages with a theme of (a) developing a personal relationship with God and (b) eternal damnation were associated with higher and lower perceptions of memorable message motivational effect, respectively. Perceived memorable message motivational effect, religious helping, and seeking religious support were indirectly associated with successful aging, via aging efficacy. Communication about religion is a worthwhile theoretical addition to the CEMSA. The use of multiple sources of data—namely the memorable message themes (as coded by outside research assistants) and subjective aging experiences (as self-reported by older adults)—is also a noteworthy methodological contribution to CEMSA research.