Perioperative acute upper gastrointestinal haemorrhage in older patients with hip fracture: incidence, risk factors and prevention
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Fisher, Leon; Fisher, Alex; Pavli, Paul; Davis, Michael W
Description
Background: No specific preventive strategy exists for acute gastrointestinal haemorrhage in hip fracture patients. Aims: To determine the effectiveness of prophylactic use of proton pump inhibitors in patients with risk factors for acute gastrointestinal haemorrhage. Methods: Prospective two-stage study of 822 consecutive older (≥60 years) hip fracture patients. Results: Acute gastrointestinal haemorrhage occurred in 16 (3.9%) of 407 patients and was associated with increased length of...[Show more]
dc.contributor.author | Fisher, Leon | |
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dc.contributor.author | Fisher, Alex | |
dc.contributor.author | Pavli, Paul | |
dc.contributor.author | Davis, Michael W | |
dc.date.accessioned | 2015-12-08T22:14:10Z | |
dc.identifier.issn | 0269-2813 | |
dc.identifier.uri | http://hdl.handle.net/1885/30114 | |
dc.description.abstract | Background: No specific preventive strategy exists for acute gastrointestinal haemorrhage in hip fracture patients. Aims: To determine the effectiveness of prophylactic use of proton pump inhibitors in patients with risk factors for acute gastrointestinal haemorrhage. Methods: Prospective two-stage study of 822 consecutive older (≥60 years) hip fracture patients. Results: Acute gastrointestinal haemorrhage occurred in 16 (3.9%) of 407 patients and was associated with increased length of hospital stay (28.7 vs. 15.9; P = 0.0027) and mortality (18.8% vs. 4.3%; P = 0.043). Multiple analysis identified five independent risk factors for acute gastrointestinal haemorrhage: pre-existing peptic ulcer (OR 4.3; P = 0.043), current smoking (OR 3.1; P = 0.023), post-operative use of an antiplatelet agent (OR 6.5; P = 0.046), post-operative use of non-steroidal anti-inflammatory drug/cyclo-oxygenase-2 inhibitor (OR 4.9; P = 0.06) and blood group O (OR 1.7; P = 0.046). These risk factors were highly sensitive and had a negative predictive value of 99.8%. Prophylactic use of proton pump inhibitors in patients with risk factor for acute gastrointestinal haemorrhage significantly reduced the incidence of this complication (0.72% in treated patients vs. 13.4% in untreated; P < 0.001); the number needed to treat was 7.9. Conclusions: In older hip fracture patients perioperative acute gastrointestinal haemorrhage occurs in 3.9% and is associated with poor outcome. Preventive proton pump inhibitor therapy in patients at risk of acute gastrointestinal haemorrhage is effective and safe. | |
dc.publisher | Wiley-Blackwell | |
dc.source | Alimentary pharmacology & therapeutics | |
dc.subject | Keywords: acetylsalicylic acid; antithrombocytic agent; clopidogrel; cyclooxygenase 2 inhibitor; esomeprazole; nonsteroid antiinflammatory agent; omeprazole; pantoprazole; proton pump inhibitor; aged; article; blood group O; controlled study; disease association; d | |
dc.title | Perioperative acute upper gastrointestinal haemorrhage in older patients with hip fracture: incidence, risk factors and prevention | |
dc.type | Journal article | |
local.description.notes | Imported from ARIES | |
local.identifier.citationvolume | 25 | |
dc.date.issued | 2007 | |
local.identifier.absfor | 110307 - Gastroenterology and Hepatology | |
local.identifier.ariespublication | u4241283xPUB71 | |
local.type.status | Published Version | |
local.contributor.affiliation | Fisher, Leon, Canberra Hospital | |
local.contributor.affiliation | Fisher, Alex, College of Medicine, Biology and Environment, ANU | |
local.contributor.affiliation | Pavli, Paul, College of Medicine, Biology and Environment, ANU | |
local.contributor.affiliation | Davis, Michael W, The Canberra Hospital | |
local.description.embargo | 2037-12-31 | |
local.bibliographicCitation.issue | 3 | |
local.bibliographicCitation.startpage | 297 | |
local.bibliographicCitation.lastpage | 308 | |
local.identifier.doi | 10.1111/j.1365-2036.2006.03187.x | |
dc.date.updated | 2015-12-08T07:48:22Z | |
local.identifier.scopusID | 2-s2.0-33846311360 | |
Collections | ANU Research Publications |
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