S1356 Gastrointestinal Bleeding Prevention With Proton Pump Inhibitor Therapy in Patients on Dual Antiplatelet Therapy: A Quality Improvement Project

Introduction: Dual anti platelet therapy (DAPT), is an essential intervention which prevents life-threatening thrombotic events in patients with cardiovascular disease. Unfortunately, it also increases the risk of gastrointestinal (GI) bleeding, ultimately worsening short and long-term outcomes. To mitigate this risk, multiple medical organizations strongly recommend prophylactic proton pump inhibitor (PPI) therapy in patients on DAPT. Our quality improvement (QI) initiative aimed to increase the uptake of PPI therapy in our patient population on DAPT. Methods: We targeted the Internal Medicine (IM) residents at our institution. IM residents are often the primary team for patients admitted with acute coronary syndrome (ACS) requiring DAPT. They are also the primary physicians for the majority of adult patients seen at our institution. We used a data collection form to assess participants’ knowledge and practices regarding the use of PPI prophylaxis in patients on DAPT. We subsequently conducted an educational session for these IM residents, focusing on the guidelines from the American College of Gastroenterology (ACG), the European Society of Cardiology (ESC), and the American Heart Association (AHA) regarding the use of PPIs for patients on DAPT. Participants completed pre- and post-session questionnaires to assess their knowledge of the risks of gastrointestinal bleeding in DAPT, the protective role of PPI co-therapy, and their willingness to incorporate PPI prescribing into future clinical practice. Results: We enrolled a total of 41 IM residents in to our QI project. Prior to our intervention, only 24.91% were aware of the need for gastro-protective agents in patients on DAPT. This rose to 89.05% post-intervention. Knowledge of the preferred agent, pantoprazole, for co-prescription with Clopidogrel improved from 57.5% to 91.9%. Before the session, 76.7% of participants routinely prescribed PPIs, either “always” or “frequently.” Post-session, this increased to 94.6%. Conclusion: Our quality improvement initiative effectively enhanced IM residents' understanding of the critical role PPIs in reducing the risk of gastrointestinal bleeding among patients on DAPT. Participants were educated about key risk factors contributing to GI bleeding and there was substantial shift to incorporating PPI co-prescription in patients on DAPT. Follow-up plans include retrospective and post-educational session chart reviews to assess improvements in PPI co-prescription rates.