Suboptimal prescribing of proton pump inhibitors in low-dose aspirin users in general practice: a population-based cohort study.

Background: Treatment of low-dose aspirin (LDASA) is recommend for the prevention of cardiovascular events in high risk patients, yet LDASA increases the risk of gastrointestinal (GI) complications. Therefore, it is recommended to treat patients at increased risk of GI complications with a concomitant proton pump inhibitor (PPI). General practitioners are not always aware of the need for gastrointestinal protection when prescribing LDASA. Objectives: We assessed adherence to recommendations of concomitant PPI treatment in regular LDASA users, taking factors associated with the probability of receiving a PPI into account. Methods: Data were obtained from the Netherlands Information Network of General Practice (LINH) database. All patients 18 years and older who were regularly prescribed LDASA (30–325 mg) in 2008– 2010 were included. Based upon HARM-WRESTLING recommendation, we categorised LDASA users into low and high GI risk. Regular medication use was defined as receiving each consecutive prescription within 6 months after the previous one. Adherence to recommendations was determined by applying multilevel multivariable logistic regression analyses in order to identifying the relative influence of patient characteristics on the probability to obtain regular PPI prescriptions in daily practice. Results: We identified 12,343 patients who started LDASA treatment, of whom 3,213 (26%) were at increased risk of GI complications. Concomitant regular use of PPI was 46% in the high GI risk group compared to 30% in the low GI risk group. In the high GI risk group 36% did not receive PPI prescriptions and 18% obtained prescriptions for PPI irregularly. In the low GI risk group 20% received irregular PPI prescriptions. Most important factors that increased the change to obtain regularly PPI prescriptions were previous GI complications, use of non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticosteroids, selective serotonin receptor inhibitors (SSRIs), drugs for functional GI disorders and age. Conclusions: More than 50% of regular LDASA users who were at increased GI risk did not receive (36%) or received irregular (18%) PPI treatment. (aut. ref.