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Abstract

Introduction: Trends in the provision stress ulcer prophylaxis (SUP) have not been assessed over a vast geographic region in nearly 10 years. Methods: This multicenter, prospective, observational cross-sectional study included adult patients admitted to an ICU in hospitals throughout the United States and Canada. Patients admitted with upper GI bleeding were excluded. The study period consisted of a single 24 hour period and data pertaining to demographics, medications used for SUP and risk factors for clinically important bleeding were collected. SUP was deemed appropriate if an AS agent was administered to patients at high risk for clinically important bleeding or no AS therapy in patients considered at low bleeding risk. High risk was defined as the presence of mechanical ventilation, coagulopathy or shock. For patients receiving AS agents prior to 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 AS therapy prior to admission were excluded. Results: There were 584 patients assessed from 58 ICUs in 27 hospitals (US, n=21; Canada, n=6). The most common type of ICU was mixed medical/surgical (35%) followed by medical (26%) and surgical (15%). Overall, SUP was considered appropriate in 78% (458/584) of patients and 68% (245/360) when patients on AS medications prior to admission were excluded. When stratified by risk, AS medications were used in 92% (333/362) of high-risk patients and 71% (157/222) of low-risk patients (p<0.001). When patients on AS medications prior to admission were excluded, AS therapy was provided to 88% (187/213) of high-risk patients and 61% (89/147) of low-risk patients (p<0.001). The most common drug class used was proton pump inhibitors (70% [342/490]). Despite receiving other enteral/oral medications, 36% (144/396) continued to receive IV AS therapy. Conclusions: SUP is frequently administered to patients who are not at high-risk for clinically important bleeding. Proton pump inhibitors are the overwhelming first choice amongst practitioners. Several opportunities exist for improved usage of AS medications for SUP.