I’ve had some wonderful guest posts in the past and I couldn’t help but notice this awesome post on LinkedIn from a fellow pharmacist! April Oliveros is the author of this quick hitter on “Does Every Patient On Anticoagulation Need a PPI?” You can connect and follow her on LinkedIn right here.
As clinical pharmacists, we strive to optimize therapy while minimizing unnecessary interventions. A common question in practice: “Should everyone on anticoagulation therapy automatically receive a proton pump inhibitor (PPI) for gastrointestinal (GI) prophylaxis?”
Short answer: No, not every patient on anticoagulants needs a PPI. While PPIs like pantoprazole are effective in reducing GI bleeding risks, their overuse can lead to adverse effects (think C. difficile infection, fractures, or kidney injury).
So, when should we consider a PPI for patients on anticoagulation? Let’s break it down:
Criteria for PPI Use in Patients on Anticoagulants
- History of GI bleeding
- Concurrent use of high-risk medications:
- Dual antiplatelet therapy (e.g., aspirin + clopidogrel)
- NSAIDs or corticosteroids
- Advanced age (≥65 years old, particularly with other risk factors)
- H. pylori infection (active or recent history)
- Severe GERD, esophagitis, or peptic ulcer disease
When PPI Use May Not Be Needed
- No history of GI bleeding
- No concomitant use of high-risk medications
- Younger, low-risk patients without additional risk factors
What the Guidelines Say
ACCP Guidelines: Recommend PPI use for anticoagulated patients with prior GI bleeding or multiple risk factors.
ESC Guidelines on Anticoagulation: Focus on balancing GI protection with risks of PPI overuse.
Take-Home Message
Does Every Patient On Anticoagulation Need a PPI? Not everyone on anticoagulation needs a PPI. Be selective! Risk stratification is key to optimizing patient outcomes while avoiding unnecessary medications.
Do you encounter frequent overprescribing of PPIs in your practice? How do you approach deprescribing when appropriate?
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