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89 PREVALENCE OF RISK FACTORS FOR GI COMPLICATIONS AND PPI USE AMONG ASPIRIN USERS A Mamfud, LE Targownik BACKGROUND: Aspirin is commonly used by patients with known cardiovascular (CV) disease. While aspirin is effective at reducing the risk of CV complications in patients with established CV disease, its use is also associated with an increased risk of gastrointestinal (GI) complications, particularly at higher doses. These complications include the development of peptic ulcer disease, which can lead to severe life-threatening sequelae including GI bleeding. The risk of GI complications increases with advanced age, multiple medical comorbidities, having a prior history of peptic ulcer disease or GI bleeding, and the concomitant use of anticoagulants, corticosteroids or nonsteroidal anti-inflammatory drugs. Furthermore, having comorbid illness, especially CV disease, may increase the case-fatality rate associated with GI bleeding. Proton pump inhibitors have been shown to dramatically reduce the risk of GI complications in high-risk aspirin users, though the extent of their use in at-risk patients is unknown. Therefore, we sought to determine the prevalence and predictors of PPI use among patients with CV disease.
Section of Gastroenterology, University of Manitoba, Winnipeg, Manitoba
METHODS: We performed a retrospective chart review of all subjects admitted to a tertiary care university-affiliated hospital between April 2004 and October 2004 with an admitting diagnosis consistent with coronary artery disease, unstable angina, myocardial infarction or congestive heart failure. We collected data on subject demographics, medication use before hospitalization, the presence of comorbid illnesses and previous GI complications, and medications at discharge.
RESULTS: Two hundred five patients were admitted during this time period with one of the aforementioned primary diagnoses. On discharge 94% of patients were using aspirin (49% at 81mg, 51% at 325 mg). Seventy-five per cent of patients admitted had at least one risk factor for GI complications in addition to having CV disease, 34% had two or more additional risk factors. When compared with patients with no additional GI risk factors, patients with GI risk factors were nearly statistically more likely to be using concomitant PPI therapy (26% vs 6%; P<0.001), and were more likely to use low dose aspirin (57% vs 32%; P=0.001). Having more than one additional GI risk factor or being on 325 mg of aspirin did not increase the likelihood of being prescribed a PPI. Of the 78% of subjects with GI risk factors discharged on aspirin who were not previously using a PPI, only 8% were prescribed a PPI on discharge.
CONCLUSIONS: Gastroprotective strategies are relatively underutilized among aspirin users at high risk for GI complications. Further work needs to be performed to encourage providers caring for patients using aspirin for prevention of CV complications to consider the use of gastroprotective strategies in patients at high risk for GI complications.
Unrestricted Grant from Altana Pharma Inc