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Study provides guidance for use of acid-suppressive medications in hospital patients
Date:1/7/2013

ht help clinicians to more appropriately prescribe these medications."

The authors examined records of 75,723 patient admissions at Beth Israel Deaconess Medical Center over a four-year period. Patients were excluded if they had been admitted to the hospital with an existing case of GI bleeding, if they developed a bleed within a day of admission or if they were scheduled to undergo cardiac catheterization, which exposes them to high levels of medications that impair clotting.

They found that gastrointestinal bleeding occurred in 203 patients over the study time-frame. The authors then used a statistical modeling technique to approximate the risk of GI bleeding associated with many different potential risk factors. "This allowed us to identify certain factors associated with significantly higher rates of bleeding," explains Herzig. "Our analysis revealed a number of independent risk factors that appeared to be associated with GI bleeds among non-ICU patients. These included being over age 60; being male; having liver disease, acute renal failure or sepsis; use of anticoagulant medication; preexisting clotting disorders; or being hospitalized on the internal medicine service.

The researchers then calculated the number of patients in each risk category that would need to be treated with acid-suppressive medication to prevent one GI bleed. "This allowed us to identify a small group of patients for whom the benefits of these medications seemed to outweigh the risks," says Herzig. "In the remaining patients, we determined that medication could be safely withheld."

While future studies will be needed to reproduce this data, adds Herzig, as a first step, the new scoring system will enable clinicians to identify the subset of patients who might benefit from prophylactic use of acid-suppressive medication, as well as a larger group for whom these medications might be safely avoided.


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Contact: Bonnie Prescott
bprescot@bidmc.harvard.edu
617-667-7306
Beth Israel Deaconess Medical Center
Source:Eurekalert

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