Gastroprotection with antiplatelets — PSA MCQ

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EasyGastroenterologyGastroprotection with antiplateletsPSA MRCGP AKT UKMLA

A 75-year-old man is reviewed after admission with an NSTEMI. He takes aspirin 75 mg once daily for secondary prevention. He had an endoscopically confirmed bleeding duodenal ulcer 2 years ago but has no current gastrointestinal bleeding. Which is the most appropriate gastroprotection strategy?

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Correct answer: A — Co-prescribe a proton pump inhibitor

A proton pump inhibitor should be co-prescribed. This patient has two important risk factors for antiplatelet-associated gastrointestinal harm: age 75 and a previous bleeding peptic ulcer. Aspirin remains indicated for secondary prevention after NSTEMI, so permanent withdrawal would expose him to avoidable cardiovascular risk; even after an acute upper gastrointestinal bleed, NICE advises continuation once haemostasis is achieved. An H2-receptor antagonist or sucralfate is not the recommended substitute for PPI gastroprotection in this high-risk setting. Continuing aspirin without gastroprotection fails to address his substantial ulcer-bleeding risk. The ongoing indication for both aspirin and the PPI should nevertheless be reviewed periodically.

Reference: Hertfordshire and West Essex ICB, Proton Pump Inhibitors and antiplatelet therapy: advisory guidance on when to initiate a PPI for gastro-protection, ratified November 2024, https://www.hweclinicalguidance.nhs.uk/all-clinical-areas-documents/download?checksum=df42e2244c97a0d80d565ae8176d3351&cid=3882