Use of proton pump inhibitors in patients with acute coronary syndrome treated with dual antiplatelet therapy: a tertiary care observation

ABSTRACT

Background: Dual antiplatelet therapy (DAPT) reduces the incidence of ischemic events and increases the risk of gastrointestinal bleeding (GIB). Proton pump inhibitors (PPIs) can be utilized to mitigate and prevent this risk; however, they are commonly underutilized. Objectives: This study evaluated PPI prescription practices and identified the factors influencing PPI use in patients with acute coronary syndrome (ACS) treated with DAPT in a regional tertiary care setting. Methods: We conducted a retrospective chart review of 310 patients with ACS treated with DAPT between 2017 and 2020. Data regarding PPI use, GIB events, and patient demographics were collected. Logistic regression was used to identify the factors associated with PPI prescriptions. Results: Among the 310 patients who met inclusion criteria, 83.3% of high-risk GIB patients received PPIs optimally, whereas 16.7% were overprescribed PPIs. In the non-PPI group, 72.7% of the high-risk patients did not receive PPIs. Significant factors influencing PPI prescribing included prior PPI use (OR 3.10, 95% CI 1.16–8.24), age ≥65 years (OR 2.55, 95% CI 1.49–4.38), and alcohol consumption (OR 2.24, 95% CI 1.04–4.81). Conclusion: The proportion of patients with ACS-DAPT with GIB risk who should receive PPI was high in Thailand. However, the optimal prescription rate was also high. A practice gap exists among patients with ACS DAPT without GIB risk because PPI are frequently overused. Age of at least 65 years, alcohol consumption, and current use of PPI significantly influenced optimal PPI prescription. Physicians should carefully consider these factors in all patients with ACS-DAPT to mitigate bleeding events.

KEYWORDS

• acute coronary syndrome
• antiplatelet agents
• proton pump inhibitors
• gastrointestinal hemorrhage
• retrospective study

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• DOI10.18549/PharmPract.2025.4.3290Copy

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