D0301 - Deprescription of Aspirin for Primary Cardiovascular Prophylaxis Is Rarely Performed at Discharge in Hospitalized Patients With Gastrointestinal Bleeding

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Darrick K. Li, MD, PhD

Yale University School of Medicine
New Haven, CT

Darrick K. Li, MD, PhD¹, Ritu Agarwal, MBBS, MS², Michelle L. Hughes, MD¹, Shawn Ong, MD, MHS¹, Kenneth W. Hung, MD, MS¹, Jamil O. Alexis, MD³, John Damianos, MD¹, Shreyak Sharma, MBBS¹, Loren Laine, MD, FACG¹
¹Yale University School of Medicine, New Haven, CT; ²Yale New-Haven Hospital, New Haven, CT; ³Bridgeport Hospital, Yale New Haven Health, Bridgeport, CT

Introduction: Guidelines recommend against aspirin for primary prophylaxis in individuals with a history of gastrointestinal bleeding (GIB). It is unknown how often patients on primary prophylaxis aspirin hospitalized with GIB have aspirin discontinued at discharge. We sought to describe clinical and hospitalization characteristics of these patients, to determine rates of aspirin deprescription, and to explore long-term outcomes including additional GIB hospitalization and major adverse cardiovascular events (MACE).

Methods: This retrospective study identified all patients on low-dose aspirin (81-325 mg daily) for primary cardiovascular prophylaxis admitted for or who developed in-hospital GIB at a large academic center between January 2014 and October 2021. Data were gathered via manual chart review. Our primary endpoint was frequency of aspirin deprescription at discharge and our secondary endpoints were post-discharge GIB hospitalization and MACE. MACE was defined as the composite outcome of myocardial infarction, stroke, and cardiovascular death. Time-to-event analysis was performed using Kaplan-Meier curves and the log rank test.

Results: We identified 320 patients (Table 1): 149 (46.6%) were male and mean age was 70.8±13.8 years. 297 (92.8%) were on aspirin 81 mg daily. 44 (13.8%) had a prior history of peptic ulcer disease. 16 (5.0%) were on chronic NSAIDs, 45 (14.1%) on SSRIs, and 15 (4.7%) on other antithrombotic agents. 172 (53.8%) patients underwent endoscopic evaluation and 9 (2.8%) had GIB-related mortality. Mean hospital length of stay was 8.7±12.5 days. 60 patients (26.9%) required endoscopic hemostatic therapy. Only 25 (7.8%) of patients were deprescribed aspirin at discharge. 260 patients had follow-up with mean follow-up time of 1152±867 days. Zero of 25 patients with aspirin deprescription had subsequent hospitalization for GIB vs. 17 (7.2%) of 235 who continued aspirin. MACE developed post-discharge in 2/25 (8.0%) with aspirin deprescription vs. 37/235 (15.7%) with aspirin continuation (p=0.278 by log-rank test for comparison of Kaplan-Meier curves) (Figure 1).

Discussion: Aspirin given for primary cardiovascular prophylaxis was rarely deprescribed at discharge in hospitalized patients with GIB. Processes designed to review all such patients at discharge and ensure appropriate deprescription of aspirin are crucial to improve adherence to guidelines, thereby reducing the risk of subsequent hospitalization for GIB without increasing the risk of MACE.

Figure: Figure 1. Time-to-event analysis of major adverse cardiac events. Kaplan-Meier curves for patients deprescribed or continued on aspirin at hospital discharge. Log rank p = 0.278.

	Full Cohort (n=320)	Aspirin Deprescribed at Discharge (n=25)	Aspirin Continued at Discharge (n=235)
Age	70.8 (13.8)
Sex (Male)	149 (46.6%)
Hypertension	278 (86.9%)
Diabetes Mellitus	137 (42.8%)
Chronic Kidney Disease	83 (25.9%)
Past History of Peptic Ulcer Disease	44 (13.8%)
ICU Admission	95 (29.7%)
Aspirin Deprescribed at Discharge	25 (7.8%)
Post-discharge MACE		2 (8.0%)	37 (15.7%)
Post-discharge GIB Hospitalization		0 (0.0%)	17 (7.2%)

*p > 0.10 for both comparisons

Table: Table 1. Baseline Characteristics of Hospitalized Patients with Gastrointestinal Bleeding on Primary Prophylaxis Aspirin and Post-Discharge Outcomes.

Disclosures:

Darrick Li indicated no relevant financial relationships.

Ritu Agarwal indicated no relevant financial relationships.

Michelle Hughes: Motus GI – Consultant.

Shawn Ong: AvoMD – Stock-privately held company.

Kenneth W. Hung indicated no relevant financial relationships.

Jamil Alexis indicated no relevant financial relationships.

John Damianos indicated no relevant financial relationships.

Shreyak Sharma indicated no relevant financial relationships.

Loren Laine: Biohaven – Adjudication committee for clinical trials (neurological medications). Celgene – Data Safety Monitoring Board for IBD clinical trials. Cerocor – Data Safety Monitoring Board for IBD clinical trials. Intercept – Adjudication committee for NASH clinical trials. Phathom – Consultant. Prometheus Bioscience – Data Safety Monitoring Board for IBD clinical trials.

Darrick K. Li, MD, PhD¹, Ritu Agarwal, MBBS, MS², Michelle L. Hughes, MD¹, Shawn Ong, MD, MHS¹, Kenneth W. Hung, MD, MS¹, Jamil O. Alexis, MD³, John Damianos, MD¹, Shreyak Sharma, MBBS¹, Loren Laine, MD, FACG¹. D0301 - Deprescription of Aspirin for Primary Cardiovascular Prophylaxis Is Rarely Performed at Discharge in Hospitalized Patients With Gastrointestinal Bleeding, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.