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T1040 Stress Bleeding Prophylaxis in Critically Ill Patients: Survey of the Clinical Practice
T1038
cirrhosis (62.8%). Amongst others, less frequently perceived were respiratory insufficiency with mechanical ventilation more than 48 hours (53.8%), or coagulopathy (30.8%). 28.2% of respondents regarded Helicobacter pylori infection as relevant. There was marked dissens in the recognization of risk factors, and 20.5% of respondents consider treatment in an ICU per se as reason to commence stress bleeding prophylaxis. Proton pump inhibitors were regarded as the drug of choice by 87% of respondents, sucralfate and histamine 2-receptor antagonists were mentioned by 14.1% each. 78.2% responded that clinical efficacy was the most important reason for choosing a special drug. 67.9% of survey respondents regarded the resolution of risk factors as a reason to discontinue stress bleeding prophylaxis. Transfer to a non-ICU ward was deemed sufficient by 28.2% of respondents, and the toleration of enteral feeds was a reason for discontinuation for 23.1%. Conclusion: There is no consensus on the use of stress bleeding prophylaxis. Implementation of guidelines might lead to reduced drug cost.
AGA Abstracts
Cost-Effectiveness of Proton Pump Inhibition Before Endoscopy in Upper Gastrointestinal Bleeding: A Cost-Effectiveness Study Alan Barkun, Viviane Adam Background & Aims: Randomized trials suggest high-dose proton pump inhibitors administered before gastroscopy in suspected upper gastrointestinal bleeding downstage bleeding ulcer stigmata. We assessed the cost-effectiveness of this approach using quality-adjusted life years that facilitate comparative decision-making across costly programs of health care delivery. Methods: A decision model compared high-dose intravenous proton pump inhibitors initiated while awaiting endoscopy, to intravenous proton pump inhibitors administration based on endoscopic findings. intravenous proton pump inhibitors were given to all patients undergoing endoscopic hemostasis for 72 hours thereafter. Once the intravenous regimen completed, or for patients with low-risk endoscopic lesions, an oral daily proton pump inhibitors was given for the remainder of the time horizon (30 days post-endoscopy). The unit of effectiveness was the quality-adjusted-life-years associated to the endoscopy, the hospitalization and the possible dyspepsia after the hospitalization. Probabilities, costs and utilities were derived from the literature and national American databases. Results: Intravenous proton pump inhibitors administration pre-endoscopy was both slightly more costly and effective than if given following gastroscopy in appropriate patients, with an average cost per patient of US$4,580 versus US$4,463 and a utility of 0.99219 quality-adjustedlife-years versus 0.99209, respectively. Because of the small incremental quality-adjustedlife-years value, the incremental cost-effectiveness ratio suggests it would cost US$1,218,213 for each additional quality-adjusted-life-year attributable to the pre-endoscopy intravenous proton pump inhibitors strategy. The intravenous proton pump inhibitors pre endoscopy strategy remained slightly more costly and effective across all one way sensitivity analyses done for all variables included in the model. Conclusions: Using conservative estimates and high-quality data for costs, probabilities and quality-adjusted-life-years, a policy of administering an intravenous proton pump inhibitors prior to endoscopy is slightly more effective and costly than waiting for the results of the gastroscopy. The appropriateness of using quality-adjusted-life-years for this short-lived condition needs assessment.
T1041 Complex Antithrombotic Therapy Prescription: Prevalence and Provider Recognition of Gastrointestinal Risks Peter J. Ramsey, Peter Richardson, Neena S. Abraham Background: Complex antithrombotic therapy (i.e. ASA + antiplatelets and/or anticoagulants) is commonly prescribed for secondary prevention of cardiovascular disease and is associated with risk of upper GI bleeding events (UGIE). Our aim was to quantify the prevalence of complex antithrombotic therapy among elderly veterans, and determine prescriber recognition of potential UGIE risk. Methods: Retrospective cohort study among veterans prescribed ASA, antiplatelets, and/or anticoagulation medication from 01/01/02 to 12/31/06 at a large VA medical center. The cohort was defined as patients prescribed two or more of the above medications concurrently for a >7 days as identified from VA prescription fill data. Electronic medical records were reviewed to assess indications for therapy, prescriber intent of therapy, patient education of treatment risks, monitoring of possible adverse events, and prophylactic measures (i.e. PPI therapy, reduction of ASA dose, avoidance of NSAIDS). Data on prescriber specialty and encounter location (inpatient or outpatient) were also collected. Descriptive analysis, chi-square testing, and multivariate multichotomous logistic analysis were performed to identify predictors of prescription strategy. Results: A total of 497 patient charts were identified and abstracted. The most commonly prescribed strategy was triple antithrombotic therapy (51.7%) and for all strategies, the prescription of ASA at a dose >81 mg/day was more common (71.4%). Common indications for complex antithrombotic medication strategies were sustained atrial fibrillation, medical management of coronary artery disease and post-percutaneous coronary intervention. Most physicians monitored patients for adverse bleeding events (57.5% versus 42.5%; p<0.001), however, few documented the need to gastroprotect patients for UGIE (17.2% versus 82.8%; p<0.001) or provided PPIs to these high risk patients (39.7% vs. 60.4%; p=0.0009). Multichotomous multivariate analysis revealed patients >65 years were more likely to be prescribed dual antithrombotic therapy (OR 3.3; 95% CI: 1.2-8.6), often for poor clinical indications (OR 0.27; 0.11-0.65) with insufficient monitoring for adverse GI events (OR 0.31; 95% CI: 0.15-0.65) and failure to gastroprotect (OR 0.20; 95% 0.09-0.69). Conclusions: Prescription of complex antithrombotic medication strategies is common among elderly veterans. Quality improvement measures should focus on improving prescriber behavior. Identifying patients at high-risk for UGIE, use of PPI prophylaxis, patient education, and careful monitoring of therapeutic parameters may improve clinical outcomes and reduce risk of UGIE.
T1039 Lower Gastrointestinal Bleeding in General Population: Preleminary Results of a French Prospective Study Including More Than 1000 Patients Christophe Pilette, Bruno Bour, Bruno Lesgourgues, Olivier Nouel, Andre-Jean Remy, Frederic Helluwaert, Jean Henrion, Roger Faroux, Gilles Macaigne, Chantal Naouri, David Bernardini, Guy Bellaiche, E. Alexandre Pariente, Herve Hagege The aim of this study was to describe current epidemiology, medical practices, morbidity and hospital mortality in a large, prospective series of lower gastrointestinal bleeding (LGIB). Patients and methods The inclusion period is scheduled to be one year, from January 2007 to December 2007. From January 1 to August 31 2007, consecutive patients with LGIB were recruited in 102 French hospitals. Clinical, biological and endoscopic data were collected until the hospital discharge. Results 1967 patients were included during this period of the study. The current analysis includes the first 1065 patients: 562 men and 539 women of mean age 71.5±16.8 years. The mode of presentation of the haemorrhage was rectal bleeding in 93.5% or melena in 6.2% of the cases. There was shock in 13.7% of patients (systolic blood pressure (SBP) <100 mmHG or loose of consciousness). Rectal bleeding was the reason for admission in 89.1% of the cases. At the admission, SBP was 125±27 mmHg and heart rate was 88±18/mn. Haemoglobin was 11.7±6 g/dl. A previous LGIB was noted in 13.1% of the cases. Before the LGIB episode, 10.9% of the patients had taken non steroidal antiinflammatory drugs, 33.5% aspirin and/or antiplatelet agents, 21.2% vitamin K antagonists and 6.9% heparin. The first lower endoscopy (rectosigmoidoscopy 35.7%, incomplete coloscopy 31.2%, total coloscopy 33.1%) was contributing to understand the mechanism of haemorraghe in 64% of the cases and then to localise the source in 79% and to attribute a cause in 96%. A second endoscopic exploration was performed in 37.5%. The cause of LGIB was attributed to: colic diverticulosis in 227 cases, ischemic colitis in 89, hemorroids in 84, colic cancer in 39, post-irradiation colitis in 17, traumatic ulceration in 13, MICI in 11, infectious colitis in 7 and other lesions in 88. Hemostatic therapy was performed during the first endoscopy in 9.1% of the cases. Transfusion of 3.5±2.2 units was realized for 34.1% of patients. Rebleeding occured among 6% of the patients. 56 patients were operated on. Morbidity without rebleeding was 12.9%. In-hospital mortality was 3.1%. In multivariate analysis, predictive factors of death were : SBP (p<0.005), heart rate (p<0.005), transfusion (p<0.005), heparin treatment (<0.001) and rebleeding (p<0.003). Conclusion During LGIB, intake of favorizing drugs is noted in more half of cases. Cause of bleeding can be identified in 60% of the cases from the first lower endoscopic examination. Colic diverticulosis is the main cause. The continuation of this study will allow knowledge of predictive factors of rebleeding and of mortality and contribute to the improvement of medical management.
T1042 Risk Factors for More Than One Upper Endoscopy During Hospitalization for Acute Upper Gastrointestinal Hemorrhage Sofyan Radaideh, Jason A. Dominitz, Dawn Provenzale, Faouzi Azzouz, Beverly S. Musick, Thomas F. Imperiale BACKGROUND: Besides rebleeding, factors associated with patients having more than one upper endoscopy (EGD) during hospitalization for acute upper GI hemorrhage (UGIH) are not well described. METHODS: We performed a nested case-control study using a dataset assembled from a 3-site, VA-based prospective study of 391 patients admitted between 1999 and 2002 with acute UGIH who were followed until discharge. Cases were patients who had more than one EGD; controls had only one EGD. In a sensitivity analysis, we matched cases with controls for age within 5 years, study site, and underlying cause of bleeding (acid-related [i.e., PUD and “-itis”] versus other). Rebleeding was defined by new hematemesis, bloody nasogastric (NG) aspirate, or bleeding documented endoscopically, along with either hypotension or a decrease in hematocrit of > 4% in a 24-hour period. Bivariate analysis was used to select factors for multiple logistic regression (P < 0.3). Independent variables from the logistic model were used to create a risk index. RESULTS: 360 (92%) of 391 subjects (mean age 63.4 +/- 13.5 years, 99% men) had at least one EGD. Among the 391 subjects, 31 (8%) rebled and 12 (3.1%) died. 39 subjects (11%) had >1 EGD, of which just 2 were for rebleeding. Of the remaining 37 subjects, the initial EGD of 11 (30%) was described as incomplete, while 9 (24%) initial EGDs involved therapeutic methods. Incomplete EGDs were more frequent when performed within 12 hours of presentation: 15% vs. 3% (P<0.001). In the unmatched analysis, 3 factors were independently associated with having >1 EGD: 1st EGD within 12 hours (OR=3.05; 95% CI, 1.42-6.52); 1st EGD performed off hours (weekends or weekdays between 5 PM and 7 AM) (OR=2.74; CI, 1.13-6.61); and an incomplete first EGD (OR=6.51; CI, 2.39-17.7). The model's c-statistic was 0.77. With one point for each variable, the risk score ranged from 0 to 3. The risk of having more than one endoscopy was 4.2 % (10/239) with a score of 0, 17% (15/86) with a score of 1, and 42% (14/33) with a score of > 1 (P<0.001). Results of the matched analysis (39 cases and 255 controls) were nearly identical to the unmatched results for both the model and risk index. CONCLUSIONS: Repeat EGD for acute UGIH occurs in 11% of cases. All 3 associated factors lend themselves to interventions (performing 1st EGD beyond 12 hours and/or during regular working hours, and use of methods to improve EGD exam quality [NG lavage, IV erythromycin]) that may improve the quality and efficiency of care delivery. Further study is needed to understand the reasons for performing more than 1 EGD in this setting.
T1040 Stress Bleeding Prophylaxis in Critically Ill Patients: Survey of the Clinical Practice Stefanie Zierhut, Sylvia Siebig, Tanja Bruennler, Falitsa Mandraka, Felix Rockmann, Antje Vasold, Julia Langgartner, Christian E. Wrede, Juergen Schoelmerich, Frank Klebl Background: Stress bleeding is associated with increased morbidity and mortality in the critically ill. There is little information on the clinical practice of bleeding prophylaxis in a broad European ICU community. Material and Methods: A questionnaire on the risk factors and clinical practice in the prophylaxis of stress related bleeding was sent to the heads of the 171 Bavarian intensive care units. The main part of the survey included specific questions to the practice of stress bleeding prophylaxis: the risk factors perceived, the drugs used, the reasons for the choice of drugs, the timing of initiation and discontinuation, the mode of administration. Results: 46% of the questionnaires were returned. 80.8% of respondents do not have a standard for stress bleeding prophylaxis. Most commonly mentioned risk factors were sepsis (73.1%), shock (67.9%), acute pancreatitis (67.9%), and acute liver failure/liver
AGA Abstracts
A-470
cirrhosis (62.8%). Amongst others, less frequently perceived were respiratory insufficiency with mechanical ventilation more than 48 hours (53.8%), or coagulopathy (30.8%). 28.2% of respondents regarded Helicobacter pylori infection as relevant. There was marked dissens in the recognization of risk factors, and 20.5% of respondents consider treatment in an ICU per se as reason to commence stress bleeding prophylaxis. Proton pump inhibitors were regarded as the drug of choice by 87% of respondents, sucralfate and histamine 2-receptor antagonists were mentioned by 14.1% each. 78.2% responded that clinical efficacy was the most important reason for choosing a special drug. 67.9% of survey respondents regarded the resolution of risk factors as a reason to discontinue stress bleeding prophylaxis. Transfer to a non-ICU ward was deemed sufficient by 28.2% of respondents, and the toleration of enteral feeds was a reason for discontinuation for 23.1%. Conclusion: There is no consensus on the use of stress bleeding prophylaxis. Implementation of guidelines might lead to reduced drug cost.
AGA Abstracts
Cost-Effectiveness of Proton Pump Inhibition Before Endoscopy in Upper Gastrointestinal Bleeding: A Cost-Effectiveness Study Alan Barkun, Viviane Adam Background & Aims: Randomized trials suggest high-dose proton pump inhibitors administered before gastroscopy in suspected upper gastrointestinal bleeding downstage bleeding ulcer stigmata. We assessed the cost-effectiveness of this approach using quality-adjusted life years that facilitate comparative decision-making across costly programs of health care delivery. Methods: A decision model compared high-dose intravenous proton pump inhibitors initiated while awaiting endoscopy, to intravenous proton pump inhibitors administration based on endoscopic findings. intravenous proton pump inhibitors were given to all patients undergoing endoscopic hemostasis for 72 hours thereafter. Once the intravenous regimen completed, or for patients with low-risk endoscopic lesions, an oral daily proton pump inhibitors was given for the remainder of the time horizon (30 days post-endoscopy). The unit of effectiveness was the quality-adjusted-life-years associated to the endoscopy, the hospitalization and the possible dyspepsia after the hospitalization. Probabilities, costs and utilities were derived from the literature and national American databases. Results: Intravenous proton pump inhibitors administration pre-endoscopy was both slightly more costly and effective than if given following gastroscopy in appropriate patients, with an average cost per patient of US$4,580 versus US$4,463 and a utility of 0.99219 quality-adjustedlife-years versus 0.99209, respectively. Because of the small incremental quality-adjustedlife-years value, the incremental cost-effectiveness ratio suggests it would cost US$1,218,213 for each additional quality-adjusted-life-year attributable to the pre-endoscopy intravenous proton pump inhibitors strategy. The intravenous proton pump inhibitors pre endoscopy strategy remained slightly more costly and effective across all one way sensitivity analyses done for all variables included in the model. Conclusions: Using conservative estimates and high-quality data for costs, probabilities and quality-adjusted-life-years, a policy of administering an intravenous proton pump inhibitors prior to endoscopy is slightly more effective and costly than waiting for the results of the gastroscopy. The appropriateness of using quality-adjusted-life-years for this short-lived condition needs assessment.
T1041 Complex Antithrombotic Therapy Prescription: Prevalence and Provider Recognition of Gastrointestinal Risks Peter J. Ramsey, Peter Richardson, Neena S. Abraham Background: Complex antithrombotic therapy (i.e. ASA + antiplatelets and/or anticoagulants) is commonly prescribed for secondary prevention of cardiovascular disease and is associated with risk of upper GI bleeding events (UGIE). Our aim was to quantify the prevalence of complex antithrombotic therapy among elderly veterans, and determine prescriber recognition of potential UGIE risk. Methods: Retrospective cohort study among veterans prescribed ASA, antiplatelets, and/or anticoagulation medication from 01/01/02 to 12/31/06 at a large VA medical center. The cohort was defined as patients prescribed two or more of the above medications concurrently for a >7 days as identified from VA prescription fill data. Electronic medical records were reviewed to assess indications for therapy, prescriber intent of therapy, patient education of treatment risks, monitoring of possible adverse events, and prophylactic measures (i.e. PPI therapy, reduction of ASA dose, avoidance of NSAIDS). Data on prescriber specialty and encounter location (inpatient or outpatient) were also collected. Descriptive analysis, chi-square testing, and multivariate multichotomous logistic analysis were performed to identify predictors of prescription strategy. Results: A total of 497 patient charts were identified and abstracted. The most commonly prescribed strategy was triple antithrombotic therapy (51.7%) and for all strategies, the prescription of ASA at a dose >81 mg/day was more common (71.4%). Common indications for complex antithrombotic medication strategies were sustained atrial fibrillation, medical management of coronary artery disease and post-percutaneous coronary intervention. Most physicians monitored patients for adverse bleeding events (57.5% versus 42.5%; p<0.001), however, few documented the need to gastroprotect patients for UGIE (17.2% versus 82.8%; p<0.001) or provided PPIs to these high risk patients (39.7% vs. 60.4%; p=0.0009). Multichotomous multivariate analysis revealed patients >65 years were more likely to be prescribed dual antithrombotic therapy (OR 3.3; 95% CI: 1.2-8.6), often for poor clinical indications (OR 0.27; 0.11-0.65) with insufficient monitoring for adverse GI events (OR 0.31; 95% CI: 0.15-0.65) and failure to gastroprotect (OR 0.20; 95% 0.09-0.69). Conclusions: Prescription of complex antithrombotic medication strategies is common among elderly veterans. Quality improvement measures should focus on improving prescriber behavior. Identifying patients at high-risk for UGIE, use of PPI prophylaxis, patient education, and careful monitoring of therapeutic parameters may improve clinical outcomes and reduce risk of UGIE.
T1039 Lower Gastrointestinal Bleeding in General Population: Preleminary Results of a French Prospective Study Including More Than 1000 Patients Christophe Pilette, Bruno Bour, Bruno Lesgourgues, Olivier Nouel, Andre-Jean Remy, Frederic Helluwaert, Jean Henrion, Roger Faroux, Gilles Macaigne, Chantal Naouri, David Bernardini, Guy Bellaiche, E. Alexandre Pariente, Herve Hagege The aim of this study was to describe current epidemiology, medical practices, morbidity and hospital mortality in a large, prospective series of lower gastrointestinal bleeding (LGIB). Patients and methods The inclusion period is scheduled to be one year, from January 2007 to December 2007. From January 1 to August 31 2007, consecutive patients with LGIB were recruited in 102 French hospitals. Clinical, biological and endoscopic data were collected until the hospital discharge. Results 1967 patients were included during this period of the study. The current analysis includes the first 1065 patients: 562 men and 539 women of mean age 71.5±16.8 years. The mode of presentation of the haemorrhage was rectal bleeding in 93.5% or melena in 6.2% of the cases. There was shock in 13.7% of patients (systolic blood pressure (SBP) <100 mmHG or loose of consciousness). Rectal bleeding was the reason for admission in 89.1% of the cases. At the admission, SBP was 125±27 mmHg and heart rate was 88±18/mn. Haemoglobin was 11.7±6 g/dl. A previous LGIB was noted in 13.1% of the cases. Before the LGIB episode, 10.9% of the patients had taken non steroidal antiinflammatory drugs, 33.5% aspirin and/or antiplatelet agents, 21.2% vitamin K antagonists and 6.9% heparin. The first lower endoscopy (rectosigmoidoscopy 35.7%, incomplete coloscopy 31.2%, total coloscopy 33.1%) was contributing to understand the mechanism of haemorraghe in 64% of the cases and then to localise the source in 79% and to attribute a cause in 96%. A second endoscopic exploration was performed in 37.5%. The cause of LGIB was attributed to: colic diverticulosis in 227 cases, ischemic colitis in 89, hemorroids in 84, colic cancer in 39, post-irradiation colitis in 17, traumatic ulceration in 13, MICI in 11, infectious colitis in 7 and other lesions in 88. Hemostatic therapy was performed during the first endoscopy in 9.1% of the cases. Transfusion of 3.5±2.2 units was realized for 34.1% of patients. Rebleeding occured among 6% of the patients. 56 patients were operated on. Morbidity without rebleeding was 12.9%. In-hospital mortality was 3.1%. In multivariate analysis, predictive factors of death were : SBP (p<0.005), heart rate (p<0.005), transfusion (p<0.005), heparin treatment (<0.001) and rebleeding (p<0.003). Conclusion During LGIB, intake of favorizing drugs is noted in more half of cases. Cause of bleeding can be identified in 60% of the cases from the first lower endoscopic examination. Colic diverticulosis is the main cause. The continuation of this study will allow knowledge of predictive factors of rebleeding and of mortality and contribute to the improvement of medical management.
T1042 Risk Factors for More Than One Upper Endoscopy During Hospitalization for Acute Upper Gastrointestinal Hemorrhage Sofyan Radaideh, Jason A. Dominitz, Dawn Provenzale, Faouzi Azzouz, Beverly S. Musick, Thomas F. Imperiale BACKGROUND: Besides rebleeding, factors associated with patients having more than one upper endoscopy (EGD) during hospitalization for acute upper GI hemorrhage (UGIH) are not well described. METHODS: We performed a nested case-control study using a dataset assembled from a 3-site, VA-based prospective study of 391 patients admitted between 1999 and 2002 with acute UGIH who were followed until discharge. Cases were patients who had more than one EGD; controls had only one EGD. In a sensitivity analysis, we matched cases with controls for age within 5 years, study site, and underlying cause of bleeding (acid-related [i.e., PUD and “-itis”] versus other). Rebleeding was defined by new hematemesis, bloody nasogastric (NG) aspirate, or bleeding documented endoscopically, along with either hypotension or a decrease in hematocrit of > 4% in a 24-hour period. Bivariate analysis was used to select factors for multiple logistic regression (P < 0.3). Independent variables from the logistic model were used to create a risk index. RESULTS: 360 (92%) of 391 subjects (mean age 63.4 +/- 13.5 years, 99% men) had at least one EGD. Among the 391 subjects, 31 (8%) rebled and 12 (3.1%) died. 39 subjects (11%) had >1 EGD, of which just 2 were for rebleeding. Of the remaining 37 subjects, the initial EGD of 11 (30%) was described as incomplete, while 9 (24%) initial EGDs involved therapeutic methods. Incomplete EGDs were more frequent when performed within 12 hours of presentation: 15% vs. 3% (P<0.001). In the unmatched analysis, 3 factors were independently associated with having >1 EGD: 1st EGD within 12 hours (OR=3.05; 95% CI, 1.42-6.52); 1st EGD performed off hours (weekends or weekdays between 5 PM and 7 AM) (OR=2.74; CI, 1.13-6.61); and an incomplete first EGD (OR=6.51; CI, 2.39-17.7). The model's c-statistic was 0.77. With one point for each variable, the risk score ranged from 0 to 3. The risk of having more than one endoscopy was 4.2 % (10/239) with a score of 0, 17% (15/86) with a score of 1, and 42% (14/33) with a score of > 1 (P<0.001). Results of the matched analysis (39 cases and 255 controls) were nearly identical to the unmatched results for both the model and risk index. CONCLUSIONS: Repeat EGD for acute UGIH occurs in 11% of cases. All 3 associated factors lend themselves to interventions (performing 1st EGD beyond 12 hours and/or during regular working hours, and use of methods to improve EGD exam quality [NG lavage, IV erythromycin]) that may improve the quality and efficiency of care delivery. Further study is needed to understand the reasons for performing more than 1 EGD in this setting.
T1040 Stress Bleeding Prophylaxis in Critically Ill Patients: Survey of the Clinical Practice Stefanie Zierhut, Sylvia Siebig, Tanja Bruennler, Falitsa Mandraka, Felix Rockmann, Antje Vasold, Julia Langgartner, Christian E. Wrede, Juergen Schoelmerich, Frank Klebl Background: Stress bleeding is associated with increased morbidity and mortality in the critically ill. There is little information on the clinical practice of bleeding prophylaxis in a broad European ICU community. Material and Methods: A questionnaire on the risk factors and clinical practice in the prophylaxis of stress related bleeding was sent to the heads of the 171 Bavarian intensive care units. The main part of the survey included specific questions to the practice of stress bleeding prophylaxis: the risk factors perceived, the drugs used, the reasons for the choice of drugs, the timing of initiation and discontinuation, the mode of administration. Results: 46% of the questionnaires were returned. 80.8% of respondents do not have a standard for stress bleeding prophylaxis. Most commonly mentioned risk factors were sepsis (73.1%), shock (67.9%), acute pancreatitis (67.9%), and acute liver failure/liver
AGA Abstracts
A-470