Pharmacoepidemiology of stress ulcer prophylaxis in the United States and Canada

• Published in: Journal of critical care 2014-12, Vol.29 (6), p.955-960
• Main Authors: Barletta, Jeffrey F., PharmD, FCCM, Kanji, Salmaan, PharmD, MacLaren, Robert, PharmD, MPH, FCCM, FCCP, Lat, Ishaq, PharmD, FCCM, FCCP, BCPS, Erstad, Brian L., PharmD, MCCM, FCCP, FASHP, BCPS
• Format: Article
• Language: English
• Subjects: Acids; Adult; Aged; Anti-Ulcer Agents - therapeutic use; Canada; Cardiovascular disease; Chronic obstructive pulmonary disease; Critical Care; Critical Illness; Cross-Sectional Studies; Epidemiology; Female; Histamine H2 Antagonists - therapeutic use; Histamine-2-receptor antagonists; Hospitalization; Humans; Infections; Intensive care; Intensive care unit; Intensive Care Units; Male; Middle Aged; Nonsteroidal anti-inflammatory drugs; Peptic Ulcer - prevention & control; Peptic Ulcer - psychology; Pharmacoepidemiology; Prospective Studies; Proton pump inhibitors; Proton Pump Inhibitors - therapeutic use; Review boards; Risk; Risk Factors; Spinal cord injuries; Stress ulcer prophylaxis; Ulcers; United States; Ventilation
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2014.06.025

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.