首页|Poor awareness of preventing aspirin-induced gastrointestinal injury with combined protective medications

Poor awareness of preventing aspirin-induced gastrointestinal injury with combined protective medications

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AIM:To investigate prescribing pattern in low-dose aspirin users and physician awareness of preventing aspirin-induced gastrointestinal (GI) injury with combined protective medications.METHODS:A retrospective drug utilization study was conducted in the 2nd Affiliated Hospital,School of Medicine,Zhejiang University.The hospital has 2300 beds and 2.5 million outpatient visits annually.Data mining was performed on all aspirin prescriptions for outpatients and emergency patients admitted in 2011.Concomitant use of proton-pump inhibitors (PPIs),histamine 2-receptor antagonists (H2RA) and mucoprotective drugs (MPs) were analyzed.A defined daily dose (DDD) methodology was applied to each MP.A further investigation was performed in aspirin users on combination use of GI injurious medicines [non-steoid anti-inflammatory drugs (NSAIDs),corticosteroids and clopidogrel and warfarin] or intestinal protective drugs (misoprostol,rebamipide,teprenone and gefarnate).Data of major bleeding episodes were derived from medical records and adverse drug reaction monitoring records.The annual incidence of major GI bleeding due to low-dose aspirin was estimated for outpatients.RESULTS:Prescriptions for aspirin users receiving PPIs,H2RA and MPs (n =1039) accounted for only 3.46％of total aspirin prescriptions (n =30 015).The ratios of coadministration of aspirin/PPI,aspirin/H2RA,aspirin/MP and aspirin/PPI/MP to the total aspirin prescriptions were 2.82％,0.12％,0.40％ and 0.12％,respectively.No statistically significant difference was observed in age between patients not receiving any GI protective medications and patients receiving PPIs,H2RA or MPs.The combined medication of aspirin and PPI was used more frequently than that of aspirin and MPs (2.82％ vs 0.40％,P ＜ 0.05) and aspirin/H2RA (2.82％ vs 0.12％,P ＜ 0.05).The values of DDDs of MPs in descending order were as follows:gefarnate,hydrotalcite ＞ teprenone ＞ sucralfate oral suspension ＞ L-glutamine and sodium gualenate granules ＞ rebamipide ＞ sucralfate chewable tablets.The ratio of MP plus aspirin prescriptions to the total MP prescriptions was as follows:rebamipide (0.47％),teprenone (0.91％),L-glutamine and sodium gualenate granules (0.92％),gefarnate (0.31％),hydrotalcite (1.00％) and sucralfate oral suspension (0.13％).Percentages of prescriptions containing aspirin and intestinal protective drugs among the total aspirin prescriptions were:rebamipide (0.010％),PPI/rebamipide (0.027％),teprenone (0.11％),PPI/teprenone (0.037％),gefarnate (0.017％),and PPI/gefarnate (0.013％).No prescriptions were found containing coadministration of aspirin and other NSAIDs.Among the 3196 prescriptions containing aspirin/clopidogrel,3088 (96.6％) prescriptions did not contain any GI protective medicines.Of the 389 prescriptions containing aspirin/corticosteroids,236 (60.7％) contained no GI protective medicines.None of the prescriptions using aspirin/warfarin (n =22) contained GI protective medicines.Thirty-five patients were admitted to this hospital in 2011 because of acute hemorrhage of upper digestive tract induced by low-dose aspirin.The annual incidence rates of major GI bleeding were estimated at 0.25％ for outpatients taking aspirin and 0.5％ for out-patients taking aspirin/warfarin,respectively.CONCLUSION:The prescribing pattern of low-dose as-pirin revealed a poor awareness of preventing GI injury with combined protective medications.Actions should be taken to address this issue.

Low-dose aspirinGastrointestinal injurySmall bowel injuryDrug utilizationPrescribing patternsCombined medicationsProton-pump inhibitorsHistamine 2-receptor antagonistsMucoprotective drugsDefined daily dose

Ling-Ling Zhu、Ling-Cheng Xu、Yan Chen、Quan Zhou、Su Zeng

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Geriatric Ward, the 2nd Affiliated Hospital,School of Medicine, Zhejiang University, Hangzhou 310009,Zhejiang Province, China

Department of Pharmacy, the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China

Department of Gastroenterology, the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China

Department of Pharmaceutical Analysis and Drug Metabolism, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, Zhejiang Province, China

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Zhejiang Provincial Bureau of HealthZhejiang Provincial Bureau of Education

2012KYA09020070227

2012

10.3748/wjg.v18.i24.3167

世界胃肠病学杂志(英文版)
太原消化病研治中心

世界胃肠病学杂志(英文版)

SCI
影响因子：1.001
ISSN：1007-9327
年,卷(期)：2012.18(24)
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