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Patients at Risk for Gastrointestinal Bleeding Infrequently Receive Proton Pump Inhibitor Therapy at Discharge

a Single Center Experience

96

Levy, Adam MD*; Katz, Philip MD

American Journal of Gastroenterology: September 2008 - Volume 103 - Issue - p S39
Supplement Abstracts Submitted for the 73rd Annual Scientific Meeting of the American College of Gastroenterology: STOMACH
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Department of Medicine, Division of Gastroenterology, Albert Einstein Medical Center, Philadelphia, PA.

Purpose: To determine the rate at which patients with myocardial infarction and risk factors for gastrointestinal bleeding who are discharged on aspirin and or clopidogrel are also discharged on PPI co-therapy.

Methods: Medical records of patients discharged from a single teaching hospital over a four-month period with a diagnosis of myocardial infarction were located retrospectively. Deidentified charts were reviewed for use of PPI, aspirin, and clopidogrel, as well as the following risk factors for gastrointestinal bleeding: age greater than or equal to 60 years, history of gastrointestinal bleeding, history of peptic ulcer disease, and use of warfarin, NSAIDs, or steroids.

Results: 164 discharges were identified, and 143 were included for review. Excluded patients had died or had incomplete charts. Mean age was 64 years (range 32–96), and 52% were male. Overall, PPI was prescribed in 40/89 (45%) discharges of patients with at least 1 risk factor for gastrointestinal bleeding who were discharged on aspirin and or clopidogrel. For those patients discharged on aspirin alone, the rates of PPI prescribing in patients with one, two, or three or more risk factors were as follows: 11/29 (38%), 4/13 (31%), 1/2 (50%). For patients discharged on aspirin combined with clopidogrel, the rates of PPI prescribing in patients with one, two, or three or more risk factors were: 13/36 (36%), 5/7 (71%), 2/3 (66%). In patients discharged on clopidogrel alone, the rates of PPI prescribing in patients with one, two, for three or more risk factors were: 0/2 (0%), 4/5 (80%), 0/0 (0). PPI therapy was discontinued during hospitalization (and at discharge) in 9/22 (41%) patients who were admitted on PPI. In patients who had PPI discontinued, 6/9 (66%) had at least one risk factor for gastrointestinal bleeding.

Conclusion: A minority of patients with myocardial infarction and risk factors for gastrointestinal bleeding were discharged on appropriate proton-pump inhibitor co-therapy. Some patients had PPI therapy discontinued despite risk factors for gastrointestinal bleeding.

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