A Retrospective Review Assessing the Efficacy of PPIs in Preventing Gastrointestinal Bleeding in Patients on DAPT: A Single Center Experience: 537

Introduction: The prolonged use of dual anti-platelet therapy (DAPT) following coronary artery stent placement is mandatory given the otherwise high risk of morbid cardiac complications. The most worrisome adverse effect of these medications is hemorrhage, namely upper and lower gastrointestinal (GI) bleeding. A few studies have suggested different prophylactic strategies with acid suppressive therapies when initiating DAPT, especially for those at an increased risk of GI bleeding. This study aims to evaluate the efficacy of proton pump inhibitors (PPI) in preventing GI bleeding for patients being started on DAPT with low dose aspirin combined with either clopidogrel, prasugrel, or ticagrelor. Primary outcome was re-admission for GI bleeding within one year of discharge. Methods: The patients included in this retrospective observational chart review study were admitted to a local tertiary medical center for acute coronary syndrome (ACS) managed with coronary artery stent placement, and therefore started on DAPT between January 2014 and December 2015. A chi square analysis was conducted to determine whether use of PPI led to a significantly lower rate of hospital readmission for GI bleeding. Results: 642 patients were included in this analysis (71.03% males, average age of 66.2 years), 191 of whom were on PPI (29.8%). 28 patients (4.35%) were readmitted for GI bleeding during the follow-up period (64.3% males, average age of 62.2 years). The average time between the index admission and readmission was 106.8 days, with an average of 1.5 readmissions. Of the patients who were readmitted with a GI bleed, 17 were indentified as upper GI bleeding, 7 were lower GI bleeding, and 4 were obscure occult bleeding. A total of 10 patients required blood product transfusion while 8 patients required endoscopic intervention. There was no significant difference in readmission rates between those who were on PPI (n=11) versus not on PPI (n=17), X2=1.27, p=0.26. No statistical significant was observed as well between the three P2Y12 receptor inhibitors along with low dose aspirin when analyzed individually and with and without PPI use. Conclusion: This analysis showed that the use of PPI did not protect against readmission for GI bleeding in ACS patients started on any DAPT regimen. Future prospective randomized research is warranted to validate potential GI prophylactic regimens for patients requiring DAPT in lieu of the PPI side effect profile.