Underutilization of gastroprotection for at risk patients undergoing percutaneous coronary intervention: Spain compared with the USA

Ruben Casado-Arroyo (1) , James M Scheiman (2) , Monica Polo-Tomas (3) , Sameer Dev Saini (4) , Alfonso del Rio (5) , Elizabeth Guastello (2) , Angel Lanas (6, 7)

1 Cardiology
2 Division of Gastroenterology
3 Division of Gastroenterology
4 Gastroenterology
5 Cardiology
6 Gastroenterology
7 Medicine

Proton-pump inhibitors (PPIs) are the preferred agents for the prevention of aspirin-associated upper gastrointestinal (UGI) bleeding. Data are limited to determine whether PPIs are being used to reduce UGI bleeding risk. Aim: To evaluate the implementation of PPI treatment to reduce the GI risk in two cardiology centers from Europe and USA. Methods: Retrospective cross-sectional study carried out at the University of Michigan and University Hospital-Zaragoza in 429 consecutive patients hospitalized for PCI on dual antiplatelet therapy. Results: Admission PPI co-therapy was similar (34% vs. 30%) in both centers. At discharge, the proportion of high-risk patients receiving PPI therapy in the Spanish center (75.4%) was higher than their American peers (55.6%) (O.R: 2.5; 95% CI; 1.3-4.7). No differences in PPI prescription rates were found among Spanish patients with/without GI risk factors. The opportunity to initiate PPI co-therapy in high-risk patients was missed in 81.8% (36/44) of those not on PPI at admission in US patients vs. 24.1% (19/79) (p < 0.0001) in Spanish patients. Conclusions: There are important differences concerning PPI prescription and risk stratification in the two centers when managing PCI patients. Efforts to stratify risks and utilize appropriate strategies for UGI bleeding prophylaxis in high-risk patients are warranted.

Mots clés: Medicine

Ruben Casado-Arroyo, James M Scheiman, Monica Polo-Tomas, Sameer Dev Saini, Alfonso del Rio, et al.. Underutilization of gastroprotection for at risk patients undergoing percutaneous coronary intervention: Spain compared with the USA. Alimentary Pharmacology and Therapeutics, 2010, ⟨10.1111/j.1365-2036.2010.04393.x⟩. ⟨hal-00552586⟩