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Stress-related mucosal bleeding in critically ill oncology patients

Division of Pharmacy, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA, jjbruno{at}mdanderson.org

Todd W Canada, PharmD BCNSP

Division of Pharmacy, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

Chris D Wakefield, BS

Department of Critical Care Medicine, Houston, TX, USA

Joseph L Nates, MD MBA-HCA FCCM

Department of Critical Care Medicine, Houston, TX, USA

Objective. To determine the incidence of stress-related mucosal bleeding (SRMB) in a critically ill oncology population receiving stress ulcer prophylaxis (SUP) with either a histamine-2 receptor antagonist (H2RA) or proton pump inhibitor (PPI). Design. Single-center, prospective, observational study.

Setting. Fifty-two bed medical-surgical intensive care unit of an academic oncology institution. Patients. A convenience sample of 100 medical and surgical critically ill oncology patients who received intensive care for more than 24 hours and at least one dose of a H2RA or PPI for prevention of SRMB.

Interventions. None.

Measurements and Main Results. Patients were followed throughout their intensive care unit stay for the development of an overt and/or clinically significant gastrointestinal (GI) bleed. More patients received a PPI (n = 81) in contrast to a H2RA (n = 19) for SUP. Overall, 94 patients (94%) had at least one risk factor for a SRMB with four patients (4%) experiencing an event (overt bleed, n=3; clinically significant bleed, n =1). All cases of GI bleeding occurred in patients receiving a PPI. No ICU deaths were considered directly related to a GI bleed.

Conclusions. The incidence of SRMB among high-risk critically ill oncology patients receiving SUP appears low; further, large-scale trials are needed to confirm this finding. J Oncol Pharm Practice (2009) 15: 9—16.

Key Words: critical illness • intensive care units • neoplasms • gastrointestinal hemorrhage • histamine H2 antagonists • proton pump inhibitors

This version was published on March 1, 2009

Journal of Oncology Pharmacy Practice, Vol. 15, No. 1, 9-16 (2009)
DOI: 10.1177/1078155208094122


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