CHICAGO — Cardiologists might not be adequately protecting their coronary artery-stenting patients against the risk of upper GI bleeding due to antiplatelet therapy, according to a poster presented at the annual Digestive Disease Week.
The study, led by Steven Chang, M.D., was a chart review of 636 randomly selected patients who received cardiovascular stents at three institutions, including Chicago's Northwestern Memorial Hospital. Most patients received aspirin before (n = 459) and/or after (n = 619) stent placement, which increased their risk of peptic ulcer-related bleeding, according to Dr. Chang and his colleagues. After stenting, however, only 155 (24%) were prescribed a proton pump inhibitor (PPI); 14 (2%) were prescribed an H2-receptor antagonist; and 1 patient was prescribed sucralfate, reported Dr. Chang, who is a consultant to Santarus, a manufacturer of omeprazole.
Some of the stent recipients had risk factors for GI bleeding besides aspirin therapy. Three patients had a documented history of upper GI bleeding, 23 had a history of peptic ulcer disease, and 30 were receiving NSAID therapy that was not stopped before stenting.
“Few coronary stent patients who are started on aspirin [therapy] and other antiplatelet agents receive appropriate GI prophylaxis,” Dr. Chang wrote. But it might not be cost effective to prescribe a PPI in all patients before stent placement, he added. “We recommend that cardiologists give PPIs to patients at risk [of upper GI bleeding] before stenting.”
Outcomes data on GI bleeding were not available in the study. Dr. Chang said a randomized trial of PPI prophylaxis is needed to determine whether PPIs prevent bleeding in this at-risk population.