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Proton-pump inhibitors use with antiplatelet agents: observational study Volume 39, issue 4, Décembre 2020

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Authors
1 Service de pharmacie, CH de Cornouaille, Quimper, France
2 Service de pharmacie, CHU de Rennes, France
3 Service de médecine interne et immunologie clinique, CHU de Rennes, France
4 Unité d’investigation clinique, Inserm 1414, CHU de Rennes, France
5 Pôle cardiovasculaire et métabolisme, CH Saint-Malo, France
* Correspondance

Antiplatelet agents expose to an important risk of gastro-intestinal bleeding. Proton pump inhibitors (PPI) seem to prevent this risk but their long-term use can be responsible of adverse effects and represents important costs. Identifying patients who would beneficiate of a PPI prevention is necessary. Different guidelines exist regarding this preventive use. The primary objective of this study was to evaluate the agreement of PPI prescriptions with the guidelines for patients treated with antiplatelet agents in Rennes’ University hospital. The secondary objective was to analyze factors associated with PPI prescription. For all patients with an antiplatelet prescription on 05/06/2019, we searched for co-prescription of a PPI as well as other known bleeding risk factors. We analyzed the agreement with the guidelines as well as the factors associated with PPI prescription. Among the 287 patients included, 126 (43.9%) were treated with a PPI. National guidelines were well respected (>80%) when a PPI was recommended. However, 56.3% of patients presenting other bleeding risk factors, not mentioned in these guidelines, were not protected by a PPI. We found no justification for 21% of all PPI prescriptions. All patients with a history of gastro-intestinal bleeding or gastro-esophageal reflux disease were protected by a PPI. Other factors significantly associated with PPI prescription were dual antiplatelet therapy (OR: 4.71 [2.14-10.34]) and anticoagulation (OR: 2.92 [1.29-6.63]). The criteria which define patients at risk should be better specified in national guidelines. Health professionals should also be sensitized to evaluate the benefit risk ratio of PPI prescription.

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