Covering the Cover

upper gastrointestinal bleeding: assessing the change in prophylaxis rate after a 10-year period There is a lack of global awareness about using proton pump inhibitors (PPI) for prophylaxis of gastrointestinal (GI) side effects among patients using these drugs as well as physicians prescribing them. A primary GI side effect is bleeding due to erosion and/or ulcers in patients who frequently use NSAIDs, antiaggregant and/or anticoagulant drugs. This issue has been reported in a previous report from Turkey which showed that only 2% of patients who were prescribed such risky medicine for GI side effects were also simultaneously put on PPI prophylaxis. Other reports also confirmed low rates of PPI prophylaxis on such patients. In the present paper, the authors have investigated the recent trend for PPI prophylaxis in GI-bleeding patients, for which they recruited 96 patients with NSAID, antiaggregant and/or anticoagulant-related upper GI bleeding. They noted that only 21% of these cases were already undergoing PPI therapy for prophylaxis against GI side effects, and 86% of the cases who were at a high risk of NSAID-related GI bleeding were not undergoing PPI prophylaxis. Out of 44 patients who were treated by a cardiologist, 34 patients were not advised to take PPIs even though they were at a high risk of GI toxicity. Thus, this study draws our attention to the insufficient use of PPI prophylaxis in patients who are on NSAID, antiaggregant, and/or anticoagulant therapy, which may potentially create life-threatening GI side effects. See page 505.