Schwaner Lauren, PharmD1, Drew Thomas, PharmD1, Vishal Kaila, MD2, Andrew Faust, PharmD1, Mark Feldman, MD1
1Texas Health Resources, Dallas, TX; 2Texas Health Presbyterian, Dallas, TX
Introduction: In patients with an upper gastrointestinal bleed, previous reports have shown that there is no difference among clinically significant endpoints when prescribed a continuous infusion of pantoprazole versus intermittent bolus administration. Our study evaluates the impact of a pharmacist-managed protocol aimed at reducing continuous infusion proton pump inhibitor use in upper gastrointestinal bleeds.
Methods: We performed a retrospective analysis of patients receiving intravenous pantoprazole for suspected upper gastrointestinal bleeding before and after the implementation of a pharmacist managed protocol. Prior to implementation, patients were continued on pantoprazole continuous infusions (8 mg/hr) at the physician’s discretion. After implementation, all hemodynamically stable patients were allowed one dose of pantoprazole as a continuous infusion(8 mg/hr for 10 hours) and then were transitioned by the pharmacist to intermittent 40 mg IV injections twice daily. The primary endpoint assessed was the incidence of upper gastrointestinal re-bleeding within 7 days of treatment. Secondary endpoints included the number of pantoprazole continuous infusions and IV push injections, number of blood transfusions, number of endoscopic interventions, length of hospital stay, and mortality.
Results: After screening 702 patients, 222 patients met inclusion criteria (115 in the pre-protocol group and 107 in the post-protocol group). The re-bleeding rate at day 7 was 7% in the pre-protocol group, compared to 4% in the post-protocol group (p=0.17). As expected, use of the protocol reduced the median number of continuous infusions per patient [4 (IQR 2-4) vs 2 (IQR 1-3); p< 0.001] and increased the median number of IV push injections [2 (IQR 2-4) vs 4 (IQR 2-7); p< 0.001] in the pre- and post-protocol groups, respectively. There were no significant differences between the pre- and post-intervention groups regarding blood transfusions (65% vs. 63%; p=0.78), endoscopic interventions (79% vs. 79%; p=1.0), hospital length of stay [4 days (IQR 3-8) vs. 4 days (IQR 2-8); p=0.521], or hospital mortality (5% vs. 2%; p=0.28)(See Table 1 and 2).
Discussion: Implementation of this pharmacy-managed protocol, allowing automatic transition from pantoprazole continuous infusions to intermittent injections in hemodynamically stable patients with an upper gastrointestinal bleed, had no detrimental effect on the incidence of re-bleeding within 7 days.
Citation: Schwaner Lauren, PharmD; Drew Thomas, PharmD; Vishal Kaila, MD; Andrew Faust, PharmD; Mark Feldman, MD. P1317 - IMPACT OF A PHARMACIST-MANAGED PROTOCOL LIMITING CONTINUOUS INFUSION OF PROTON PUMP INHIBITOR USE IN PATIENTS WITH AN UPPER GASTROINTESTINAL BLEED. Program No. P1317. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.