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GASTROPROTECTIVE STRATEGIES ARE POORLY UTILIZED IN HIGH RISK ASPIRIN USERS
LE Targownik, CJ Metge, S Leung, B Anderson
INTRODUCTION: Aspirin is widely used for the prevention of complications of cardiovascular disease. However, aspirin is associated with an increased risk of developing severe upper gastrointestinal complications due to peptic ulcer disease. Proton pump inhibitors (PPIs) have been shown to profoundly decrease the risk of complications of peptic ulcer disease among aspirin users. However, there are no consensus guidelines regarding the use of gastroprotective strategies for long-term aspirin users.
METHODS: A survey was distributed to a random sample of 3,500 Manitobans age =>50 with a known history of established cardiac disease and all 637 Manitobans age =>50 with known cardiac disease and hospital admission for a complication of peptic ulcer disease. Subjects were queried as to their use of aspirin, and over the counter NSAIDs and antacids, and were also asked about the presence of gastrointestinal symptoms, including GERD and abdominal pain, and their assessment of their personal risk of aspirin related complication. Returned surveys were linked to the Manitoba Health database to determine prescription drug utilization and the presence of medical comorbidities. We calculated the proportion of people with and without a history of peptic ulcer disease currently using aspirin, and the proportion of each using concurrent PPI therapy. We also calculated the rates of PPI co-therapy among aspirin users with any of the known risk factors for aspirin-related GI complications (use of clopidogrel, other NSAIDs, warfarin, systemic corticosteroids, age =>70, and other medical comorbidities).
RESULTS: Overall response rate was 35%. Aspirin use was high among the cohort with no history of PUD (89%) and those with a history of PUD (78%). 45% of persons with a history of a hospital admission for PUD did not receive a concurrent PPI. Only 22% of aspirin users with at least one additional risk factor for GI complications were using a PPI. A history of GERD increased the likelihood of PPI use, but none of the risk factors associated with GI complications was associated with PPI use.
CONCLUSION: Gastroprotection with PPIs was underutilized in aspirin users at risk for GI complications. This represents a gap in practice which needs to be addressed. Further educational and interventional efforts are required to increase awareness of the need for gastroprotective strategies in high risk aspirin users and to encourage their use.
This research was funded by an Investigator-Initiated Grant awarded by Janssen-Ortho Canada