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Underutilization of Peptic Ulcer Disease Prophylaxis Among Elderly Users of Antiplatelets and Anticoagulants

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Abstract

Introduction

Peptic ulcer disease (PUD) develops in approximately 25% of chronic users of non-steroidal anti-inflammatory drugs (NSAIDs). The incidence of uncomplicated PUD has been declining over the past 3 decades unlike that of complicated PUD in the elderly. An expert consensus document published jointly in 2008 by the American College of Gastroenterology (ACG), the American College of Cardiology Foundation (ACCF), and the American Heart Association (AHA) provided recommendations on prevention of PUD among users of antiplatelets and anticoagulants. This work aimed to evaluate physicians’ compliance with these guidelines in a tertiary academic setting.

Methods

We examined our medical record database for the 9 month period extending from April 2018 until December 2018. Using this database, we identified elderly patients (> 64 years old) who were chronic (> 3 months) users of low dose aspirin (81 mg once daily) and had an indication for PUD prophylaxis as per the ACG–ACCF–AHA guideline document. We performed a retrospective chart review of patients included in this study. Descriptive statistics were compared using χ2 and independent sample t tests.

Results

A total of 852 patients were included in this study. The mean age was 75 years old, and 43% of patients were females. In addition to aspirin, patients were prescribed P2Y12 inhibitors (45.5%), direct oral anticoagulants (DOACs) (23%), warfarin (12%), steroids (9%) or enoxaparin (1%). Users of DOACs were most commonly prescribed apixaban (16%), followed by rivaroxaban (6%) and dabigatran (1%). Overall, only 40% of patients with an indication for PUD prophylaxis received a proton pump inhibitor.

Conclusion

PUD prophylaxis may be underutilized in elderly patients. This finding, along with increasing rates of NSAID use and an aging population, may help explain the increased incidence of complicated PUD in the elderly. Efforts are needed to raise physician awareness of PUD prophylaxis guidelines.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, 3635 Vista Ave, 9th Floor FDT, St Louis, MO, 63104, USA

    Ahmad M. Al-Taee & Christine Y. Hachem

  2. Department of Internal Medicine, Saint Louis University School of Medicine, 3635 Vista Ave, 9th Floor FDT, St Louis, MO, 63104, USA

    Ahmad M. Al-Taee, Elie Ghoulam & Christine Y. Hachem

  3. Saint Louis University School of Medicine, 3635 Vista Ave, 9th Floor FDT, St Louis, MO, 63104, USA

    Preston Lee & Mitchell Edwards

  4. Department of Internal Medicine, Washington University in St Louis, St Louis, MO, USA

    Kahee A. Mohammed

Authors
  1. Ahmad M. Al-Taee
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  2. Elie Ghoulam
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Contributions

AMA and CYH: study concept and design. AMA, EG, PL, ME, and CYH: data collection and writing manuscript. KAM: statistical analysis. The final version of this manuscript have been reviewed and approved by all authors prior to submission.

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Correspondence to Ahmad M. Al-Taee.

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Al-Taee, A.M., Ghoulam, E., Lee, P. et al. Underutilization of Peptic Ulcer Disease Prophylaxis Among Elderly Users of Antiplatelets and Anticoagulants. Dig Dis Sci 66, 3476–3481 (2021). https://doi.org/10.1007/s10620-020-06665-w

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  • DOI: https://doi.org/10.1007/s10620-020-06665-w

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