Patients who are prescribed triple antithrombotic therapy, which usually consists of an oral anticoagulant alongside dual antiplatelet therapy, are known to be at a very high risk of gastrointestinal bleeding. Current national guidelines recommend that these patients should routinely receive a proton pump inhibitor to reduce this risk. Despite the strength of this recommendation, experience in everyday practice suggests that compliance is often variable, and patients may be left unprotected against a potentially preventable complication.

This audit aims to explore how well gastroprotection guidance is followed in a large UK teaching hospital. Using retrospective data collection, we will identify all patients prescribed triple therapy during the study period. For each case, we will record key details including demographics, indication for treatment such as atrial fibrillation or acute coronary syndrome, specific antithrombotic regimen, presence or absence of a concurrent proton pump inhibitor prescription, and whether a formal bleeding risk assessment using the ORBIT score was documented.

The primary outcome measure will be the proportion of patients appropriately co-prescribed a proton pump inhibitor in line with guideline standards. Secondary outcomes will examine variation in practice between different clinical teams and whether bleeding risk assessments influence prescribing behaviour.

By establishing a clear baseline of current practice, this project will highlight gaps in safe prescribing and identify opportunities for improvement. The findings are intended to guide future interventions and raise awareness of this important patient safety issue. Ultimately, ensuring that patients on triple therapy receive adequate gastroprotection has the potential to reduce preventable gastrointestinal bleeding and improve outcomes for a group already recognised as being at high risk.