Proton Pump Inhibitors Use for Stress Ulcer Prophylaxis in Non-Critically Ill Patients
DOI:
https://doi.org/10.24950/rspmi/original/115/1/2019Keywords:
Gastrointestinal Hemorrhage/prevention & control, Peptic Ulcer/prevention & control, Proton Pump InhibitorsAbstract
Introduction: The use of proton pump inhibitors (PPIs) has
a well-established role in the prophylaxis of gastrointestinal
bleeding in critically care patients; however, its use in non-intensive care patients is controversial. The authors proposed to
evaluate the prescription of PPIs as gastrointestinal bleeding
prophylaxis during hospitalization of non-critically ill patients,
including the indication and costs.
Material and Methods: A prospective, observational, cross-sectional study. All patients admitted to our medical department
during a 31 day period were included. At the time of admission,
a gastrointestinal bleeding risk score was completed by the attending physician. A score equal or greater than 10 points identified appropriateness of PPIs for prophylactic therapy. Costs
with PPI use were collected on the study period.
Results: During the study period, 115 patients were admitted,
of which 99 were included in the study (54.5% women, mean
age 76.2 years). Of the gastrointestinal bleeding risk factors assessed: 28.3% acute kidney injury, 10.1% liver disease, 20.2%
sepsis, 40.4% prophylactic anticoagulation, and 30.3% coagulopathy. According to the score used, 67.7% of the patients
were in low or low-medium risk and 32.4% in high-medium or
high risk. During hospitalization, 59.6% of the patients received
PPIs, 45.8% of which inappropriately according to the risk
score. The total cost of PPIs use was 101.9€, with an inappropriate spending of 46.6€ during a 31 day period in our Internal
Medicine department alone.
Conclusions: PPIs use was prevalent in non-critically ill patients
(59.6%), of which 45.8% were inappropriate, representing a
problem associated with iatrogenic risk and economic impact.
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