608 Prevalence of Acid Suppressive Prophylaxis in Hospitalized Patients for Peptic Ulcer Disease and Complications: Retrospective Study

Abstract

INTRODUCTION: An NSAID is present in about 8% of all prescriptions written by primary care physicians. Among GI-related adverse drug events, 23.5% were related to NSAIDs, 45% were considered avoidable. Risk factors associated with peptic ulcer disease include: History of peptic ulcer or ulcer bleeding, positive status of H Pylori, age (>65 years), Concomitant use of warfarin, steroids, anti-platelets. Study in France, showed that gastroprotection was not prescribed in 16% of patients on NSAIDs and risk factors for GI toxicity. Misoprostol and PPI therapy are proved to reduce the risk of GI toxicity. Current guidelines recommend that high risk patients should be prescribed COX2 selective agents by itself or non-selective agents with gastroprotection. METHODS: We performed a retrospective chart review of patients at Truman Medical Center Hospital Hill, Missouri who were hospitalized for NSAID-related peptic ulcer disease from the time period of January 2013 till September 2018. We further included only patients with risk factors of peptic ulcer disease and should have been on gastroprotective agents prior to presentation. RESULTS: Our sample included 81 patients hospitalized for NSAID-related peptic disease with risk factors for peptic ulcer disease. Mean age was 58.2 years old. More than half of patients were male (56.8%). Around 47% were smokers and 41% were alcohol current users. Around third of patients were taking aspirin daily and only 13% were on anticoagulation. More than half of patient had History of peptic ulcer (52%) and 38% had history of bleeding ulcer. Only 44.4% of our patients were on gastroprotective agents prior to presentation. Significant portion of our sample presented with ulcer complication (i.e., bleeding, perforation) at 74.1% (60/81). About 60% of patient were anemic at presentation. 31% of patients presented with significant bleeding requiring more than 2 units of packed RBC. Gastroprotective agent prescription prior to presentation was significantly associated with aspirin use (P-value 0.038), anticoagulation (P-value 0.023), Hx coronary artery disease (P-value 0.023), history of peptic ulcer in the past (P-value 0.002) and anemia (P-value 0.003). CONCLUSION: Significant portion of patients who were hospitalized with peptic ulcer disease complications were not on gastroprotective agents although indicated. Risk stratification and PPI prescription when appropriate should be implemented more aggressively in outpatient setting.