Pharmacoepidemiology of stress ulcer prophylaxis in the United States and Canada

American-Canadian consortium for Intensive care Drug utilization (ACID) Investigators

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Purpose: This study sought to identify the medication class most commonly prescribed for stress ulcer prophylaxis (SUP), assess trends in SUP utilization, and report the use of acid suppressive therapy stratified by bleeding risk. Materials and methods: This multicenter, prospective, point prevalence study reviewed adult patients over a 24-hour period for demographics, medications used for SUP, and risk factors for clinically important bleeding. Stress ulcer prophylaxis was deemed appropriate if acid suppressive therapy was administered to patients at high risk for bleeding or no therapy in patients considered at low bleeding risk. High risk was defined as the presence of mechanical ventilation, coagulopathy, or shock. For patients receiving acid suppression before hospital admission, SUP was considered appropriate if the same drug class was continued regardless of risk factors. A planned subgroup analysis was conducted whereby patients on acid suppressive medications before admission were excluded. Results: There were 584 patients from 58 intensive care units in 27 hospitals. The most common drug class was proton pump inhibitors (70%). Despite receiving other enteral/oral medications, 36% received intravenous acid suppressive therapy. Overall, SUP was considered appropriate in 78% of patients and 68% when patients on acid suppression before admission were excluded. When stratified by risk, acid suppressive medications were used in 92% of high-risk patients and 71% of low-risk patients. Conclusion: Stress ulcer prophylaxis is frequently administered to patients who are not at high risk for clinically important bleeding. Proton pump inhibitors are the overwhelming first choice among practitioners. Several opportunities exist for improvement regarding the provision of SUP.

Original languageEnglish (US)
Pages (from-to)955-960
Number of pages6
JournalJournal of Critical Care
Volume29
Issue number6
DOIs
StatePublished - Dec 1 2014

Fingerprint

Pharmacoepidemiology
Ulcer
Canada
Acids
Hemorrhage
Proton Pump Inhibitors
Therapeutics
Artificial Respiration
Pharmaceutical Preparations
Small Intestine
Intensive Care Units
Shock

Keywords

  • Epidemiology
  • Histamine-2-receptor antagonists
  • Intensive care unit
  • Proton pump inhibitors
  • Stress ulcer prophylaxis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

American-Canadian consortium for Intensive care Drug utilization (ACID) Investigators (2014). Pharmacoepidemiology of stress ulcer prophylaxis in the United States and Canada. Journal of Critical Care, 29(6), 955-960. https://doi.org/10.1016/j.jcrc.2014.06.025

Pharmacoepidemiology of stress ulcer prophylaxis in the United States and Canada. / American-Canadian consortium for Intensive care Drug utilization (ACID) Investigators.

In: Journal of Critical Care, Vol. 29, No. 6, 01.12.2014, p. 955-960.

Research output: Contribution to journalArticle

American-Canadian consortium for Intensive care Drug utilization (ACID) Investigators 2014, 'Pharmacoepidemiology of stress ulcer prophylaxis in the United States and Canada', Journal of Critical Care, vol. 29, no. 6, pp. 955-960. https://doi.org/10.1016/j.jcrc.2014.06.025
American-Canadian consortium for Intensive care Drug utilization (ACID) Investigators. Pharmacoepidemiology of stress ulcer prophylaxis in the United States and Canada. Journal of Critical Care. 2014 Dec 1;29(6):955-960. https://doi.org/10.1016/j.jcrc.2014.06.025
American-Canadian consortium for Intensive care Drug utilization (ACID) Investigators. / Pharmacoepidemiology of stress ulcer prophylaxis in the United States and Canada. In: Journal of Critical Care. 2014 ; Vol. 29, No. 6. pp. 955-960.
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abstract = "Purpose: This study sought to identify the medication class most commonly prescribed for stress ulcer prophylaxis (SUP), assess trends in SUP utilization, and report the use of acid suppressive therapy stratified by bleeding risk. Materials and methods: This multicenter, prospective, point prevalence study reviewed adult patients over a 24-hour period for demographics, medications used for SUP, and risk factors for clinically important bleeding. Stress ulcer prophylaxis was deemed appropriate if acid suppressive therapy was administered to patients at high risk for bleeding or no therapy in patients considered at low bleeding risk. High risk was defined as the presence of mechanical ventilation, coagulopathy, or shock. For patients receiving acid suppression before hospital admission, SUP was considered appropriate if the same drug class was continued regardless of risk factors. A planned subgroup analysis was conducted whereby patients on acid suppressive medications before admission were excluded. Results: There were 584 patients from 58 intensive care units in 27 hospitals. The most common drug class was proton pump inhibitors (70{\%}). Despite receiving other enteral/oral medications, 36{\%} received intravenous acid suppressive therapy. Overall, SUP was considered appropriate in 78{\%} of patients and 68{\%} when patients on acid suppression before admission were excluded. When stratified by risk, acid suppressive medications were used in 92{\%} of high-risk patients and 71{\%} of low-risk patients. Conclusion: Stress ulcer prophylaxis is frequently administered to patients who are not at high risk for clinically important bleeding. Proton pump inhibitors are the overwhelming first choice among practitioners. Several opportunities exist for improvement regarding the provision of SUP.",
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AU - Patel, Jignesh

AU - Connor, Kathryn

AU - Groth, Christine

AU - Falvey, Jennifer

AU - Acquisto, Nicole

AU - Dzierba, Amy

AU - Patel, Mona

AU - Muir, Justin

AU - Park, Linda

AU - Hall-Zimmerman, Lisa

AU - Faris, Janie

AU - Roberts, Russel

AU - Thomas, Zachariah

AU - Patel, Ruchi

AU - Ahrens, Christine

AU - Gladden, Dustin

AU - Wahby, Krista

AU - Hodgman, Tudy

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AU - Saccucci, Paola

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N2 - Purpose: This study sought to identify the medication class most commonly prescribed for stress ulcer prophylaxis (SUP), assess trends in SUP utilization, and report the use of acid suppressive therapy stratified by bleeding risk. Materials and methods: This multicenter, prospective, point prevalence study reviewed adult patients over a 24-hour period for demographics, medications used for SUP, and risk factors for clinically important bleeding. Stress ulcer prophylaxis was deemed appropriate if acid suppressive therapy was administered to patients at high risk for bleeding or no therapy in patients considered at low bleeding risk. High risk was defined as the presence of mechanical ventilation, coagulopathy, or shock. For patients receiving acid suppression before hospital admission, SUP was considered appropriate if the same drug class was continued regardless of risk factors. A planned subgroup analysis was conducted whereby patients on acid suppressive medications before admission were excluded. Results: There were 584 patients from 58 intensive care units in 27 hospitals. The most common drug class was proton pump inhibitors (70%). Despite receiving other enteral/oral medications, 36% received intravenous acid suppressive therapy. Overall, SUP was considered appropriate in 78% of patients and 68% when patients on acid suppression before admission were excluded. When stratified by risk, acid suppressive medications were used in 92% of high-risk patients and 71% of low-risk patients. Conclusion: Stress ulcer prophylaxis is frequently administered to patients who are not at high risk for clinically important bleeding. Proton pump inhibitors are the overwhelming first choice among practitioners. Several opportunities exist for improvement regarding the provision of SUP.

AB - Purpose: This study sought to identify the medication class most commonly prescribed for stress ulcer prophylaxis (SUP), assess trends in SUP utilization, and report the use of acid suppressive therapy stratified by bleeding risk. Materials and methods: This multicenter, prospective, point prevalence study reviewed adult patients over a 24-hour period for demographics, medications used for SUP, and risk factors for clinically important bleeding. Stress ulcer prophylaxis was deemed appropriate if acid suppressive therapy was administered to patients at high risk for bleeding or no therapy in patients considered at low bleeding risk. High risk was defined as the presence of mechanical ventilation, coagulopathy, or shock. For patients receiving acid suppression before hospital admission, SUP was considered appropriate if the same drug class was continued regardless of risk factors. A planned subgroup analysis was conducted whereby patients on acid suppressive medications before admission were excluded. Results: There were 584 patients from 58 intensive care units in 27 hospitals. The most common drug class was proton pump inhibitors (70%). Despite receiving other enteral/oral medications, 36% received intravenous acid suppressive therapy. Overall, SUP was considered appropriate in 78% of patients and 68% when patients on acid suppression before admission were excluded. When stratified by risk, acid suppressive medications were used in 92% of high-risk patients and 71% of low-risk patients. Conclusion: Stress ulcer prophylaxis is frequently administered to patients who are not at high risk for clinically important bleeding. Proton pump inhibitors are the overwhelming first choice among practitioners. Several opportunities exist for improvement regarding the provision of SUP.

KW - Epidemiology

KW - Histamine-2-receptor antagonists

KW - Intensive care unit

KW - Proton pump inhibitors

KW - Stress ulcer prophylaxis

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