title: Pharmacoepidemiology of stress ulcer prophylaxis in the United States and Canada.
abstract: OBJECTIVE
  This study sought to identify the medication class most commonly prescribed for stress ulcer prophylaxis (SUP), assess trends in SUP utilization, and report the use of acid suppressive therapy stratified by bleeding risk.
  
  
  METHODS
  This multicenter, prospective, point prevalence study reviewed adult patients over a 24-hour period for demographics, medications used for SUP, and risk factors for clinically important bleeding. Stress ulcer prophylaxis was deemed appropriate if acid suppressive therapy was administered to patients at high risk for bleeding or no therapy in patients considered at low bleeding risk. High risk was defined as the presence of mechanical ventilation, coagulopathy, or shock. For patients receiving acid suppression before 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 acid suppressive medications before admission were excluded.
  
  
  RESULTS
  There were 584 patients from 58 intensive care units in 27 hospitals. The most common drug class was proton pump inhibitors (70%). Despite receiving other enteral/oral medications, 36% received intravenous acid suppressive therapy. Overall, SUP was considered appropriate in 78% of patients and 68% when patients on acid suppression before admission were excluded. When stratified by risk, acid suppressive medications were used in 92% of high-risk patients and 71% of low-risk patients.
  
  
  CONCLUSIONS
  Stress ulcer prophylaxis is frequently administered to patients who are not at high risk for clinically important bleeding. Proton pump inhibitors are the overwhelming first choice among practitioners. Several opportunities exist for improvement regarding the provision of SUP.
authors: Department of Pharmacy Practice Midwestern University, College of Pharmacy, Glendale, AZ. Electronic address: jbarle@midwestern.edu.
authors: Jeffrey F
authors: JF
authors: Barletta
authors: The Ottawa Hospital Research Institute, Clinical Pharmacy Specialist, The Ottawa Hospital, Ottawa, Ontario, Canada. Electronic address: skanji@toh.on.ca.
authors: Salmaan
authors: S
authors: Kanji
authors: Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO. Electronic address: Rob.maclaren@ucdenver.edu.
authors: Robert
authors: R
authors: MacLaren
authors: Department of Pharmacy Services, University of Chicago Medical Center, Chicago, IL. Electronic address: Ishaq.lat@uchospitals.edu.
authors: Ishaq
authors: I
authors: Lat
authors: Department of Pharmacy Practice and Science, University of Arizona, College of Pharmacy, Tucson, AZ. Electronic address: Erstad@pharmacy.arizona.edu.
authors: Brian L
authors: BL
authors: Erstad
mesh_terms: D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D002170:Canada; D016638:Critical Illness; D003430:Cross-Sectional Studies; D005260:Female; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000517:prevention & control* / Q000523:psychology; D017891:Pharmacoepidemiology; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012306:Risk; D012307:Risk Factors; D014481:United States
chemical_list: D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors
keywords: Epidemiology; Histamine-2-receptor antagonists; Intensive care unit; Proton pump inhibitors; Stress ulcer prophylaxis