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GI BLEEDING IS RARE IN ICU PATIENTS.

Critically ill patients in intensive care units often receive prophylaxis to prevent gastrointestinal bleeding. Because such therapy is expensive and may increase the risk for nosocomial pneumonia, this prospective study asked how often such bleeding occurs and whether it can be predicted.

The study involved 2252 patients admitted to medical or surgical ICUs in Canada. Attending physicians were encouraged to withhold prophylaxis except in the most severely injured patients; about 30 percent of patients received it.

Only 1.5 percent of patients had clinically important bleeding, and only two factors predicted who would bleed: respiratory failure (odds ratio, 15.6) and coagulopathy (4.3). Patients with one or both of these risk factors had a 3.7 percent chance of bleeding, whereas those with neither factor had a 0.1 percent chance.

Comment: This large, careful study underlines the fact that GI bleeding is unusual in critically ill patients and is most apt to occur in patients with certain easily ascertained risk factors. Patients without these factors are unlikely to benefit from prophylaxis. The authors conclude that prophylaxis has value in patients with either risk factor, but a randomized trial is needed to support this conclusion, since bleeding is uncommon even in this subgroup.

— AL Komaroff

Published in Journal Watch General Medicine February 25, 1994

Citation(s):

Cook DJ et al. Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med 1994 Feb 10 330 377-381.

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