Enteric-coated aspirin use in acute chest pain in Saudi Arabia: a cross-sectional study of practice patterns and systemlevel implications

Objective: This study aimed to assess aspirin formulation use for acute chest pain in emergency departments and primary care centers in Saudi Arabia, with a focus on Ministry of Health facilities. Methods: A cross-sectional, anonymous, convenience-based electronic survey was conducted among the healthcare professionals involved in the care of patients with acute chest pain in the Ministry of Health emergency departments and primary care centers. The survey assessed aspirin formulation, dose, and method of administration, as well as knowledge regarding enteric-coated aspirin absorption, availability of non-enteric aspirin, and willingness to change practice. Results: A total of 58 participants, most of whom worked in emergency departments (79.3%) and were emergency physicians (74.1%), were included. Enteric-coated aspirin was reported as the most commonly used formulation for acute chest pain (57%), most often administered by swallowing the tablet whole (58.6%), and 69.0% of participants were aware that enteric-coated aspirin has delayed absorption. Only 32.8% reported that non-enteric aspirin formulations were readily available in their facility. In exploratory analyses, enteric-coated aspirin use was more commonly reported when non-enteric aspirin was unavailable than when it was available (81.8% vs. 31.6%; Fisher’s exact test, p = 0.0016). A large majority of participants indicated willingness to use non-enteric aspirin if available (81.0%) and supported system-wide standardization of non-enteric aspirin use (77.6%). Conclusion: Enteric-coated aspirin was commonly used for acute chest pain in surveyed Ministry of Health settings in Saudi Arabia despite guideline recommendations favoring non-enteric formulations. This practice appeared to be influenced by system-level factors, particularly medication availability, more than by knowledge alone.