PMID- 35898254 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230802 IS - 0018-5787 (Print) IS - 1945-1253 (Electronic) IS - 0018-5787 (Linking) VI - 57 IP - 4 DP - 2022 Aug TI - Pre-Endoscopy Use of Proton Pump Inhibitor Intravenous Bolus Dosing in Hemodynamically Stable Patients With Suspected Upper Gastrointestinal Bleeding: Results of a Pharmacist-Managed Hospital Protocol to Reduce Continuous Infusion Pantoprazole Use. PG - 448-454 LID - 10.1177/00185787211046854 [doi] AB - Background: Guidelines for acute upper gastrointestinal bleeding (UGIB) recommend use of proton pump inhibitors (PPI) administered by continuous IV infusion (CI). Although data suggest comparable outcomes with CI and IV push (IVP) dosing post-endoscopy, there are limited data to support IVP PPI as the pre-endoscopy regimen. Objective: To evaluate the impact of a pharmacist-managed protocol for reducing PPI CIs and substitution of PPI IVP dosing in hemodynamically stable patients with suspected acute upper gastrointestinal bleeding (UGIB) prior to endoscopic intervention. Design, Setting, and Participants: Retrospective study; Tertiary-care community teaching hospital; Hemodynamically stable adults with confirmed or suspected UGIB. Hemodynamic stability was defined as a systolic blood pressure >90 mmHg, heart rate <100 beats, mean arterial pressure >65 mmHg, and no requirement for vasopressors. Intervention: All iterations of treatment recommendations encouraged an initial pantoprazole 80 mg IVP dose. In the pre-intervention group, patients were then treated at the at the provider's discretion with the majority receiving CI pantoprazole. After implementation of the original protocol (Phase I), all hemodynamically stable patients were allowed 1 bag of CI pantoprazole (80 mg infused over 10 hours) before being transitioned by the pharmacist to pantoprazole 40 mg IVP every 12 hours. After internal analysis, the protocol was revised to allow patients to be immediately transitioned to IVP dosing without an initial CI (Phase II). Main Outcome: Incidence of continued bleeding or re-bleeding within 7 days of initial PPI dose. Results: A total of 325 patients were included across all 3 study phases. The median number of CI bags per patient was reduced from 4 pre-intervention, to 1.5 in phase I, and to 0 in phase II (P < .001). The primary endpoint of continued bleeding or re-bleeding within 7 days was similar across all 3 groups (5.0% vs 6.5% vs 5.2%, P = .92). Mean intravenous pantoprazole costs were reduced by $21.73/patient. Conclusions: Movement toward preferential use of IVP PPI prior to endoscopy for hemodynamically stable patients with confirmed or suspected UGIBs resulted in similar rates of continued bleeding or re-bleeding and generated modest cost savings. These findings warrant further investigation. CI - (c) The Author(s) 2021. FAU - Faust, Andrew C AU - Faust AC AUID- ORCID: 0000-0002-3024-9611 AD - Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA. FAU - Schwaner, Lauren AU - Schwaner L AD - Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA. AD - Tufts Medical Center, Boston, MA, USA. FAU - Thomas, Drew AU - Thomas D AD - Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA. AD - Baylor Scott & White All Saints Medical Center, Fort Worth, TX, USA. FAU - Sannapanei, Shilpa AU - Sannapanei S AD - Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA. FAU - Feldman, Mark AU - Feldman M AD - Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA. AD - University of Texas Southwestern Medical School, Dallas, TX, USA. LA - eng PT - Journal Article DEP - 20210916 PL - United States TA - Hosp Pharm JT - Hospital pharmacy JID - 0043175 PMC - PMC9310314 OTO - NOTNLM OT - gastric acid secretion OT - pantoprazole OT - proton pump inhibitors OT - upper gastrointestinal bleeding COIS- Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2022/07/29 06:00 MHDA- 2022/07/29 06:01 PMCR- 2023/08/01 CRDT- 2022/07/28 02:04 PHST- 2022/07/28 02:04 [entrez] PHST- 2022/07/29 06:00 [pubmed] PHST- 2022/07/29 06:01 [medline] PHST- 2023/08/01 00:00 [pmc-release] AID - 10.1177_00185787211046854 [pii] AID - 10.1177/00185787211046854 [doi] PST - ppublish SO - Hosp Pharm. 2022 Aug;57(4):448-454. doi: 10.1177/00185787211046854. Epub 2021 Sep 16.