Key result
In veteran patients on combined antithrombotic therapy, PPI co-therapy was utilized in 40.9% of patients, and the FFRS score outperformed HAS-BLED for predicting gastrointestinal bleeding (P=0.0094).
Why the study?
Concomitant anticoagulant and antiplatelet therapy increases gastrointestinal bleed risk, and PPIs have been proposed to decrease this risk, prompting evaluation of PPI utilization and GIB predictors in veterans on CAT.
What is the utilization rate of PPIs in veteran patients on combined antithrombotic therapy, and what are the clinical predictors of gastrointestinal bleeding?
Cohort (n=1,181)
What is the utilization rate of PPIs in veteran patients on combined antithrombotic therapy, and what are the clinical predictors of gastrointestinal bleeding?
In veteran patients on combined antithrombotic therapy, PPI co-therapy is underutilized (40.9%), and a simplified five-factor risk score outperforms HAS-BLED in predicting gastrointestinal bleeding.
PPI gastroprotection may be underused in veterans on combined antithrombotic therapy; leaves open whether FFRS outperforms HAS-BLED prospectively.
BACKGROUND: Concomitant use of anticoagulant and antiplatelet agents can increase the risk of gastrointestinal bleed (GIB). Use of proton pump inhibitors (PPIs) has been proposed to decrease the risk of GIB in patients on combined antithrombotic therapy (CAT). OBJECTIVE: To describe the current utilization of PPIs in veteran patients on CAT and associated clinical predictors of GIB. METHODS: This retrospective study included patients on CAT receiving PPIs, with at least one of the CAT agents initiated between January 1, 2018 and October 30, 2018. Data were extracted from the computerized patient record system. Primary end point included estimating proportion of patients on CAT receiving PPI co-therapy, describing patient characteristics, and identifying clinical predictors of GIB. Secondary outcomes included reporting GIB events and all-cause mortality. Additional outcome was to validate the five-factor risk score (FFRS) for GIB in patients on CAT and compare its overall predictive performance to HAS-BLED score. RESULTS: This study reports an overall rate of PPI co-therapy in patients on CAT of 40.9% (484/1181), with only 22.3% of patients on CAT receiving PPI for GIB prophylaxis. There was no difference in the mean follow up duration of PPI users and PPI co-therapy (264.01 vs 271.92 days; p=0.3761). Current alcohol use (p=0.005), current smokers (p=0.022), chronic kidney disease (p=0.004), peptic ulcer disease (p<0.001), and non-steroidal anti-inflammatory drug use (p=0.048) were significant predictors of GIB in multivariate analyses of our study cohort. We further provide exploratory validation that use of a simplified FFRS to predict GIB showed a trend towards better overall predictive performance as compared to HAS-BLED score (C-statistic: 0.738; 95% CI 0.684-0.787 for FFRS vs C-statistic: 0.596; 95% CI 0.538-0.653 for HAS-BLED; p=0.0094). CONCLUSION: This study reports lower rate of PPI co-therapy in veteran patients on CAT per currently available guidance. Further we explore utilization of simplified FFRS model to predict GIB in patients on CAT with long-term PPI co-therapy.
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Patil et al. (2020) conducted a cohort in Combined antithrombotic therapy (n=1,181). Proton pump inhibitors (PPIs) vs. No PPI co-therapy was evaluated on Proportion of patients on combined antithrombotic therapy receiving PPI co-therapy. In veteran patients on combined antithrombotic therapy, PPI co-therapy was utilized in 40.9% of patients, and the FFRS score outperformed HAS-BLED for predicting gastrointestinal bleeding (P=0.0094).
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