Key result
Prophylactic proton pump inhibitors in older hip fracture patients with risk factors significantly reduced acute gastrointestinal haemorrhage compared to no treatment (0.72% vs 13.4%; P<0.001).
Why the study?
Does prophylactic use of proton pump inhibitors reduce acute gastrointestinal haemorrhage in older patients with hip fracture and risk factors?
Cohort (n=822)
Does prophylactic use of proton pump inhibitors reduce acute gastrointestinal haemorrhage in older patients with hip fracture and risk factors?
Number Needed to Treat: 7.9
Absolute Event Rate: 0.72% vs 13.4%
Number Needed to Treat: 7.9
p-value: p=<0.001
Prophylactic proton pump inhibitors effectively and safely reduce the incidence of acute gastrointestinal hemorrhage in older hip fracture patients with risk factors.
May support PPI prophylaxis in high-risk elderly hip fracture patients; leaves open need for RCTs to confirm causality.
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 (> or =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.
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Fisher et al. (2007) conducted a cohort in Hip fracture (n=822). Proton pump inhibitors vs. Untreated was evaluated on Acute gastrointestinal haemorrhage (NNT 7.9, p=<0.001). Prophylactic proton pump inhibitors in older hip fracture patients with risk factors significantly reduced acute gastrointestinal haemorrhage compared to no treatment (0.72% vs 13.4%; P<0.001).
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