ACS And GI Bleeding PPI Indication Tool

ACS And Gastrointestinal Bleeding PPI Indication Tool. Explanation And Clinical Context This tool is designed for patients with acute coronary syndrome who receive dual antiplatelet therapy oral anticoagulant therapy or both. The twenty twenty five ACC AHA ACS guideline states that in patients at high risk of gastrointestinal bleeding a proton pump inhibitor should be used together with dual antiplatelet therapy oral anticoagulant therapy or both to reduce bleeding risk.

The recommendation is supported by clinical trials showing that proton pump inhibitors significantly lower gastrointestinal bleeding among patients treated with aspirin dual antiplatelet therapy or oral anticoagulant therapy without a clear signal of excess ischemic events. In this tool high gastrointestinal risk is approximated by a history of gastrointestinal bleeding or ulcer complications advanced age and concomitant chronic use of NSAID or systemic steroid. When at least one of these factors is present in a patient receiving intensive antithrombotic therapy a proton pump inhibitor is strongly recommended.

When antithrombotic intensity is high but no gastrointestinal risk factor is present routine proton pump inhibitor therapy is not mandatory yet may be considered on an individual basis. If the patient has gastrointestinal risk factors but is not on dual antiplatelet therapy or oral anticoagulant therapy chronic proton pump inhibitor treatment can still be reasonable for gastrointestinal protection with the understanding that the link to acute coronary syndrome therapy is weaker and decisions should be individualized. Reference Rao SV O Donoghue ML Ruel M et al.

Twenty twenty five ACC AHA ACEP NAEMSP SCAI Guideline for the Management of Patients with Acute Coronary Syndromes. J Am Coll Cardiol. Twenty twenty five.