P4179 - The Impact of Proton Pump Inhibitors on the Efficacy and Safety of Dual Antiplatelet Therapy Following Intracranial and Carotid Artery Stent Placement: A Retrospective Cohort Study in an Underserved Community Hospital

Ahmet Sakiri, MD¹, Amir Sakiri, BS², Abu Fahad Abbasi, MD¹, Fahad Mehmood, MD¹, Fahad Sarvari, MD³, Sabah Mahmood, MD¹, Mudassar Sandozi, DO¹, Ammar Aqeel, MD⁴, Luqman Baloch, MD¹, Thayer Hamoudah, MD¹, Naser Khan, MD¹, Vibhav Bansal, MD¹, Altaf Dawood, MD, MBBS^1
1Mercy Health, Rockford, IL; ²Loyola University, Rockofrd, IL; ³Mercyhealth, Rockford, IL; ⁴Mercy Health, Loves Park, IL

Introduction: This study investigates the effects of proton pump inhibitors (PPIs) in patients on dual antiplatelet therapy (DAPT) following intracranial (IC) or internal carotid artery (ICA) stenting. ACG recommends PPIs in high-risk GI bleeding. The AHA/ASA 2021 guidelines recommend PPIs for those with prior GI bleeds. European guidelines recommend PPIs all on DAPT. Limited evidence exists regarding PPI safety in intracranial stents.

Methods: Adult patients discharged on DAPT following IC or ICA stenting between January 2019 and January 2023 were screened using "Get With The Guidelines" registry. 1778 patients were extracted for review. Patients with a PPI on discharge were compared to those without one. Primary outcomes were GI bleeds, stroke recurrence, and stent failure.

Results: Out of 230 patients who underwent ICA stenting, 151 met inclusion criteria. 40 patients were on a PPI at discharge. There were 6 stroke recurrences post-discharge, only 1 of which was on a PPI (pantoprazole). No stent failures were observed. The Pearson Chi-Square statistic was 0.330, p-value 0.566. Fisher's Exact Test showed two-sided significance of 1.000, indicating no significant association between PPI use at discharge and stroke recurrence. Notably, GI bleeds requiring hospital admission (n=17) were more frequent in patients not on a PPI at discharge (n=13).

29 patients with IC stents were reviewed. 19 met inclusion criteria. 8 were on a PPI at discharge. There were 2 stroke recurrences post-discharge, none on a PPI. One stent occlusion due to medication non-adherence was noted. Pearson Chi-Square for PPIs and stent failures was 0.847, p-value 0.357. Fisher's Exact Test (two-sided) was 1.000, and (one-sided) was 0.556, indicating no significant association between PPIs and stent failures. For PPIs and stroke recurrence, the Pearson Chi-Square statistic was 1.800, p-value 0.180, and Fisher's Exact Test (two-sided) was 0.477, indicating no significant association. One GI bleed requiring admission occurred in a patient not on a PPI at discharge.

Discussion: This study supports the use of PPIs in preventing GI bleeds in patients at risk for GI toxicity and indicates that PPIs may be safe in IC and ICA stents. Clopidogrel and omeprazole are metabolized by cytochrome CYP450 2C19, potentially reducing clopidogrel's efficacy. Ticagrelor does not interact with PPIs as it does not require hepatic metabolism. Pantoprazole, a weak inhibitor of CYP2C19. Those at risk for GI bleeds should be on a PPI, preferably pantoprazole.


Disclosures:


Ahmet Sakiri, MD¹, Amir Sakiri, BS², Abu Fahad Abbasi, MD¹, Fahad Mehmood, MD¹, Fahad Sarvari, MD³, Sabah Mahmood, MD¹, Mudassar Sandozi, DO¹, Ammar Aqeel, MD⁴, Luqman Baloch, MD¹, Thayer Hamoudah, MD¹, Naser Khan, MD¹, Vibhav Bansal, MD¹, Altaf Dawood, MD, MBBS¹. P4179 - The Impact of Proton Pump Inhibitors on the Efficacy and Safety of Dual Antiplatelet Therapy Following Intracranial and Carotid Artery Stent Placement: A Retrospective Cohort Study in an Underserved Community Hospital, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.