599 Assessing Adherence to ACG Guidelines on Restarting Low-Dose Aspirin After Upper Gastrointestinal Bleed Secondary to Ulcers

Abstract

INTRODUCTION: American College of Gastroenterology (ACG) guidelines in 2012 recommend that if low-dose aspirin (LDA) is used as secondary prophylaxis then LDA should be restarted as soon as possible with daily proton pump inhibitor (PPI) therapy in patients who achieve hemostasis after an upper gastrointestinal bleed (UGIB) secondary to an ulcer. It is not recommended to restart LDA for primary prophylaxis. METHODS: Retrospective chart review was performed on patients at our hospital center, Mount Sinai Beth Israel, who required an esophagogastroduodenoscopy (EGD) for UGIB secondary to ulcers during a hospital stay from February 2012 to December 2018. Patients were included if they were on LDA prior to EGD intervention. The percentage of included patients who were on LDA for primary prophylaxis and discontinued on discharge was calculated. The percentage of patients who were on LDA for secondary prophylaxis and restarted on LDA at discharge was calculated to assess the level of adherence to the guidelines. Subgroups within the secondary prophylaxis LDA group were also evaluated for adherence with chi-square tests to determine significance. RESULTS: 155 patients who met the inclusion criteria were reviewed. The mean age was 73 years. Females (67, 43%). Caucasian (52, 33.6%), African American (12, 7.7%), Hispanic (35, 22.6%), Asian (51, 32.9%). 40 patients were on LDA for primary prophylaxis and 115 for secondary prophylaxis. Of those on LDA for primary prophylaxis, 28 (70%) were not restarted on LDA at discharge. Of those on LDA for secondary prophylaxis, 59 (51.3%) were restarted on LDA at hospital discharge. There was no significant difference in the decision to restart secondary prophylaxis LDA on discharge based on gender (P = 0.36) or race (P = 0.69). Additionally, there was no significant difference based on whether patients were taking another anticoagulant (P = 0.78), needed a second EGD (P = 0.09), required endoscopic hemostasis intervention (P = 0.71), or were indicated to receive blood transfusions (P = 0.83). CONCLUSION: This study showed that only about half of ulcer-related UGIB subjects on LDA for secondary prophylaxis were restarted on LDA and 70% on LDA for primary prophylaxis were not restarted on LDA at discharge based on suggested ACG guidelines at our institution. The decision to restart secondary prophylaxis LDA was independent of age, gender, and severity of gastrointestinal bleed. Therefore, greater awareness and education among hospital physicians is needed to improve adherence rates.