Wiener Medizinische Wochenschrift

, Volume 162, Issue 3–4, pp 67–73 | Cite as

Individualised PPI prescription in patients on combination antiplatelet therapy and upper gastrointestinal events after percutaneous coronary intervention: a cohort study

  • Rahel Häuptle
  • Daniel Weilenmann
  • Tino Schneider
  • Sarah R. Haile
  • Peter Ammann
  • Christina Knellwolf
  • Jan Borovicka
Original article

Summary

BACKGROUND: We investigated the effect of individualised proton pump inhibitors (PPI) prescription on upper gastrointestinal adverse events in a cohort of patients who received combination antiplatelet therapy (aspirin and clopidogrel) after percutaneous coronary intervention (PCI). METHODS: Upper gastrointestinal risk factors and other parameters were extracted from a dedicated electronic database. Patients were contacted with a standardised questionnaire. A structured phone interview was performed in all patients with upper gastrointestinal adverse events. RESULTS: A cohort of 718 patients on combination therapy yielded 87 (12.1%) patients with prophylactic PPI treatment. Upper gastrointestinal adverse events occurred in 18.4% patients with and in 11.1% patients without prophylactic PPI (OR 1.80, P = 0.054). Co-treatment with corticosteroids was the main identifiable risk factor for upper gastrointestinal adverse events (adjusted OR 5.45, P = 0.014). CONCLUSIONS: Individualised prescription of PPI-prophylaxis after PCI in patients on combined antiplatelet therapy based on risk assessment for upper gastrointestinal bleeding seems to represent an effective measure to minimise upper gastrointestinal adverse events after PCI.

Keywords

Combination antiplatelet therapy Prophylactic proton pump inhibitor Upper gastrointestinal adverse event Gastrointestinal risk factor 

Individualisierte Protonenpumpeninhibitor (PPI)-Gabe bei Patienten mit kombinierter Thrombozytenaggregationshemmung (Aspirin und Clopidogrel) und unerwünschten gastrointestinalen Ereignissen nach perkutaner koronarer Intervention (PCI): Eine Kohortenstudie

Zusammenfassung

GRUNDLAGEN: In einer Patientenkohorte, welche nach perkutaner koronarer Intervention (PCI) kombinierte Thrombozytenaggregationshemmung (Aspirin und Clopidogrel) erhielt, wurde die Wirksamkeit einer individualisierten PPI-Gabe zur Reduktion unerwünschter gastrointestinaler Ereignisse untersucht. METHODIK: Das gastrointestinale Risikofaktorprofil und andere Parameter wurden aus einer speziell angelegten elektronischen Datenbank extrahiert. Die Patienten wurden via standardisierten Fragebogen kontaktiert und bei Patienten mit unerwünschten gastrointestinalen Ereignissen wurde zusätzlich ein strukturiertes Telefoninterview durchgeführt. ERGEBNISSE: In einer Kohorte von 718 Patienten erhielten 87 (12,1 %) eine prophylaktische PPI-Therapie. Bei insgesamt 12 % wurden unerwünschte gastrointestinale Ereignisse gefunden, wobei 18,4 % eine PPI-Prophylaxe und 11,1 % kein PPI hatten (OR 1,80, P = 0,054). Eine Komedikation mit Steroiden war der hauptsächliche Risikofaktor für unerwünschte gastrointestinale Ereignissen (adjusted OR 5,45, P = 0,014). SCHLUSSFOLGERUNGEN: Die individualisierte PPI-Therapie basierend auf einer Risikoabschätzung für gastrointestinale Blutungsereignisse scheint ein effizientes Instrument zu sein, um gastrointestinale Ereignisse nach PCI zu minimieren.

Schlüsselwörter

Kombinierte Thrombozytenaggregationshemmung Proton pump inhibitor-Prophylaxe Gastrointestinale Nebenwirkung Gastrointestinaler Risikofaktor 

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Rahel Häuptle
    • 1
    • 2
  • Daniel Weilenmann
    • 3
  • Tino Schneider
    • 4
  • Sarah R. Haile
    • 5
    • 6
  • Peter Ammann
    • 3
  • Christina Knellwolf
    • 7
  • Jan Borovicka
    • 7
  1. 1.University of ZurichZurichSwitzerland
  2. 2.Department of Internal MedicineSpital Herisau, Appenzell AusserrhodenHerisauSwitzerland
  3. 3.Department of Internal MedicineCardiology, Kantonsspital St. GallenSt. GallenSwitzerland
  4. 4.Department of Internal MedicinePneumology, Kantonsspital GraubündenChurSwitzerland
  5. 5.Division of Biostatistics, Institute for Social and Preventive MedicineUniversity of ZurichZurichSwitzerland
  6. 6.Clinical Trials UnitKantonsspital St. GallenSt. GallenSwitzerland
  7. 7.Department of Internal Medicine, Gastroenterology and HepatologyKantonsspital St. GallenSt. GallenSwitzerland

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