Abstract
Proton pump inhibitors (PPIs), followed by histamine 2 receptor antagonists (H2RAs), are the most commonly used drugs to prevent gastrointestinal bleeding in critically ill patients through stress ulcer prophylaxis. The relative efficacy and drug-related adverse events of PPIs and H2RAs remain unclear. In this retrospective, observational, comparative cohort study, PPIs and H2RAs for stress ulcer prophylaxis in critically ill patients were compared using a common data model. After propensity matching, 935 patients from each treatment group (PPI or H2RA) were selected. The PPI group had a significantly higher 90-day mortality than the H2RA group (relative risk: 1.28; P = 0.01). However, no significant inter-group differences in the risk of clinically important gastrointestinal bleeding were observed. Moreover, there were no significant differences between the groups concerning the risk of pneumonia or Clostridioides difficile infection, which are known potential adverse events related to these drugs. Subgroup analysis of patients with high disease severity were consistent with those of the total propensity score-matched population. These findings do not support the current recommendations, which prefer PPIs for gastrointestinal bleeding prophylaxis in the intensive care unit.
Highlights
Proton pump inhibitors (PPIs), followed by histamine 2 receptor antagonists (H2RAs), are the most commonly used drugs to prevent gastrointestinal bleeding in critically ill patients through stress ulcer prophylaxis
Proton pump inhibitors (PPIs) are the most commonly used drugs in intensive care units (ICUs) to prevent gastrointestinal tract (GI) bleeding caused by stress ulcers, followed by histamine 2 receptor antagonists (H2RAs)[5]
Concerns about adverse events associated with these drugs, including pneumonia and Clostridioides difficile infection, have been raised, with some studies suggesting that these risks peak shortly after starting the drugs, which is the case of most patients in the I CU6–11
Summary
Proton pump inhibitors (PPIs), followed by histamine 2 receptor antagonists (H2RAs), are the most commonly used drugs to prevent gastrointestinal bleeding in critically ill patients through stress ulcer prophylaxis. The relative efficacy and drug-related adverse events of PPIs and H2RAs remain unclear In this retrospective, observational, comparative cohort study, PPIs and H2RAs for stress ulcer prophylaxis in critically ill patients were compared using a common data model. Subgroup analysis of patients with high disease severity were consistent with those of the total propensity score-matched population These findings do not support the current recommendations, which prefer PPIs for gastrointestinal bleeding prophylaxis in the intensive care unit. Proton pump inhibitors (PPIs) are the most commonly used drugs in intensive care units (ICUs) to prevent GI bleeding caused by stress ulcers, followed by histamine 2 receptor antagonists (H2RAs)[5]. Concerns about adverse events associated with these drugs, including pneumonia and Clostridioides difficile infection, have been raised, with some studies suggesting that these risks peak shortly after starting the drugs, which is the case of most patients in the I CU6–11
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