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Targeting the Use of Acid Suppressants in Hospital Patients
Gastrointestinal (GI) bleeds that occur in the hospital, although rare, can be a significant source of morbidity and mortality. Currently, the prophylactic use of acid-suppressive medication in hospitalized, non-critically ill patients is not widely recommended. Despite this, these medications continue to be widely used for this purpose.
Researchers at Beth Israel Deaconess Medical Center in Boston, Mass., believe that there is a group of patients whose risk of GI bleeds is high enough to warrant the routine prescription of acid-suppressive medication, as well as a larger group in whom these medications can be safely withheld. The new study, which developed a risk scoring system to identify these patient groups, was published online in the Journal of General Internal Medicine.
Recent studies have found that the risk of GI bleeding in hospitalized, non-critically ill patients is fairly low. However, some patients will be at greater risk for this complication than others, and no method is currently available to help medical staff identify those most likely to experience a GI bleed. The researchers therefore set out to find factors that might identify which patients were most at risk to help target the use of prophylactic acid-suppressive medication for patients who need it, and to withhold such medication in the rest.
The researchers reviewed 75,723 admissions at their institution over a 3-year period. Patients were excluded from the analysis if they were admitted with GI bleeding, developed a bleed within 1 day of admission, or were scheduled to undergo cardiac catheterization. GI bleeds occurred in a total of 203 patients.
The researchers identified independent risk factors that increased the likelihood of a GI bleed. These factors were: age greater than 60 years; male sex; the presence of liver disease, acute renal failure, or sepsis; being on a medicine service; the use of prophylactic anticoagulants; and the presence of coagulopathy. This information enabled the investigators to develop a risk scoring system to identify high-risk groups. They found that the risk of GI bleeding increased directly in line with these clinical risk factors.
The researchers emphasize that further studies are needed to reproduce their data. However, their scoring system allows the identification of a subset of patients who may benefit from the prophylactic use of acid-suppressive therapy, as well as a larger group in whom these medications can safely be avoided.