Identifying and Prophylaxis of High-risk GI Bleeders in Cardiac Patients

Abstract

Purpose: Identification of individuals at risk for gastrointestinal bleeding is extremely important because it is associated with increased mortality and morbidity. Risk factors associated with GI bleeding have been identified as age >64, hx of peptic ulcer disease, H. pylori infection, dyspepsia or GERD symptoms, chronic renal failure, diabetes mellitus, and concomitant use of other antiplatelet agents, anticoagulants, nonsteroidal anti-inflammatory drugs, and steroids. Recommendations made in 2010 ACC/ACG/AHA expert consensus recommend GI prophylaxis for all patients undergoing percutaneous coronary intervention (PCI) who are at high risk of adverse GI event consequent to therapy. Our purpose is to emphasize the importance of GI bleeding risk stratification and prophylaxis in patients prior to antithrombotic therapy in PCI. Methods: Retrospective study on 200 patients admitted to Plaza Medical Center in Fort Worth, TX, for percutaneous cardiac intervention requiring antithrombotic therapy from June 2010 to June 2011. We examined cardiology consults and identified risk factors for GI bleeding reported in past medical history, medications and review of systems. Next set of data was based on whether patients with three or more risk factors were appropriately placed on GI prophylaxis with a proton pump inhibitor. Results: Gastrointestinal risk factors were identified in PMH and medications. In ROS, no consults included pertinent positives or negatives regarding previous PUD, dyspepsia, reflux or bloatiness. Patients with or without risk factors were placed on pepcid. Patients with protonix on their medication lists were switched to pepcid. As a result, no one was appropriately placed on a proton pump inhibitor for prophylaxis. Conclusion: Gastrointestinal bleed is a common medical condition resulting in high medical care costs. There are many ways to improve the identification of patients at risk. Efforts should be aimed at increasing the awareness and promoting adequate history taking with emphasis on past medical history, medication list and review of systems. High-risk patients should be appropriately placed on GI prophylaxis with a proton pump inhibitor.