Proton pump inhibitors (PPIs) reduce the risk of upper gastrointestinal hemorrhage (UGIH) associated with the use of many medications.
To examine how clinicians perceive such risk and whether PPI coprescribing is based on an accurate assessment.
Clinicians in a single teaching hospital were asked to estimate risk of UGIH and comment on PPI coprescription in hypothetical patients. Records of 160 hospital in-patients (median age; 74 y) were then reviewed to examine PPI prescribing and risk factors for UGIH.
In general, clinicians estimated UGIH risk accurately and reported low thresholds for PPI coprescription. Prescribing records showed regular PPI use increased between admission and discharge of patients from 61/160 (38%) to 93/160 (58%). Ten percent had a prior history of peptic ulcer disease. Proton pump inhibitor prescription was significantly associated with the use of aspirin and clopidogrel. Half of the patients with multiple risk factors for UGIH on admission and almost a third at discharge were not coprescribed a PPI.
Clinicians generally estimate correctly the risk of UGIH and report a low threshold for prescribing gastro-protection. Despite this, prescribing practice does not consistently take account of relative risk of UGIH. Targeted PPI coprescribing on the basis of risk factors would lead to more rational PPI use.
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Division of Gastroenterology and Hepatology, Beaumont Hospital, Royal College of Surgeons, Beaumont, Dublin, Ireland
No funding sources to acknowledge.
Reprints: Frank E. Murray, MD, Division of Gastroenterology and Hepatology, Beaumont Hospital, Royal College of Surgeons, Beaumont, Dublin 9, Ireland (e-mail: firstname.lastname@example.org).
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Received for publication January 26, 2009
accepted April 10, 2009
None of the authors have any conflict of interest to declare.