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Perioperative acute upper gastrointestinal haemorrhage in older patients with hip fracture: incidence, risk factors and prevention

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.authorFisher, Leon
dc.contributor.authorFisher, Alex
dc.contributor.authorPavli, Paul
dc.contributor.authorDavis, Michael W
dc.date.accessioned2015-12-08T22:14:10Z
dc.identifier.issn0269-2813
dc.identifier.urihttp://hdl.handle.net/1885/30114
dc.description.abstractBackground: 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.publisherWiley-Blackwell
dc.sourceAlimentary pharmacology & therapeutics
dc.subjectKeywords: 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.titlePerioperative acute upper gastrointestinal haemorrhage in older patients with hip fracture: incidence, risk factors and prevention
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume25
dc.date.issued2007
local.identifier.absfor110307 - Gastroenterology and Hepatology
local.identifier.ariespublicationu4241283xPUB71
local.type.statusPublished Version
local.contributor.affiliationFisher, Leon, Canberra Hospital
local.contributor.affiliationFisher, Alex, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationPavli, Paul, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationDavis, Michael W, The Canberra Hospital
local.description.embargo2037-12-31
local.bibliographicCitation.issue3
local.bibliographicCitation.startpage297
local.bibliographicCitation.lastpage308
local.identifier.doi10.1111/j.1365-2036.2006.03187.x
dc.date.updated2015-12-08T07:48:22Z
local.identifier.scopusID2-s2.0-33846311360
CollectionsANU Research Publications

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