Amanda Neal, PharmD
PGY2 Critical Care Pharmacy Resident
n/a
Savannah, Georgia
Disclosure information not submitted.
Sofiya Sovalska, PharmD, BCCCP
Critical Care Pharmacist
Memorial Health University Medical Center, United States
Disclosure information not submitted.
Title: Gastrointestinal Bleeding in Cardiac Surgery Patients With or Without Stress Ulcer Prophylaxis
Introduction: Proton pump inhibitors and histamine-2 receptor antagonists are utilized for critically ill patients as stress ulcer prophylaxis (SUP). Literature supporting routine utilization of stress ulcer prophylaxis is largely based on studies conducted in the 1980s and 1990s. The incidence of stress-related mucosal gastrointestinal (GI) bleeding in cardiac surgery patients has been shown to be low. However, cardiothoracic surgery patients may have additional risk factors for developing stress ulcers such as prolonged bypass times under surgery, antiplatelet and anticoagulant utilization, advanced age, and blood transfusions. The objective of this study was to identify the incidence of bleeding in patients who did and did not receive stress ulcer prophylaxis.
Methods: This was a single-center, retrospective, IRB-approved study conducted from January 1, 2020 to December 31, 2020. Adult patients admitted for cardiothoracic procedures (coronary artery bypass, valve replacement, aortic dissection repair or replacement, and ablation) were eligible for study inclusion. Exclusion criteria included pregnant and incarcerated patients. The primary outcome was incidence of GI bleeding during hospital stay. Stress ulcer prophylaxis was defined as receiving famotidine or pantoprazole for greater than 48 hours. Secondary outcomes were hospital length of stay, hospital mortality, other bleeding events, and hospital acquired pneumonia or Clostridioides difficile infection.
Results: A total of 100 out of 441 patients met inclusion criteria. Fifty patients in were included in each group. No significant difference in the incidence of GI bleeding was noted between groups: 1 (2%) patient in the non-stress ulcer prophylaxis group versus 2 (4%) in the stress ulcer prophylaxis group (p=1). There was no significant difference in the length of stay, hospital mortality, and other bleeding events between groups. No statistically significant differences in incidence of Clostridioides difficile infections and pneumonia was observed between groups.
Conclusions: There was not a significant difference in the incidence of GI bleeding between cardiac surgery patients receiving versus not receiving stress ulcer prophylaxis. At our facility, we did not observe additional benefit of stress ulcer prophylaxis in cardiothoracic surgery patients.