Proton-pump inhibitors: use and effectiveness in ACS patients receiving dual antiplatelet therapy

We performed a cross-sectional study to determine the frequency of use of proton-pump inhibitors (PPIs) in acute coronary syndrome (ACS) patients on dual antiplatelet therapy (DAPT) within 24 hours of hospital admission, and their effectiveness in reducing bleeding complications. This cross-sectional study included a total of 83 patients admitted via the medical take to Queen Elizabeth Hospital, Lewisham and Greenwich Trust (LGT), London, with ACS from May 2022 to June 2022. The data of these patients were analysed to see whether ACS patients on DAPT were given PPIs within 24 hours of their hospital admission. These patients were further assessed for any bleeding event during their hospital admission and its association with the prescription of PPIs. A significant number of ACS patients (26, 32.1%) were not prescribed PPIs within 24 hours of hospital admission. However, 55 (67.9%) patients were prescribed PPIs within 24 hours of their hospital admission. Of the 26 ACS patients not given PPIs within 24 hours of their hospital admission, three patients developed bleeding complications during their admission. Two out of the three patients developed gastrointestinal (GI) bleeding (melena) with a significant drop in their haemoglobin levels, while one patient developed haematuria. In conclusion, a large number of patients admitted with ACS and started on DAPT did not receive a concomitant PPI within 24 hours of admission to the hospital in accordance with European Society of Cardiology (ESC) and American Heart Association (AHA) guidelines, and, as such, were at significant risk of bleeding events.