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Adherence and Adequacy of Therapy for Esophageal Varices Prophylaxis.
MedLine Citation:
PMID:  21614592     Owner:  NLM     Status:  Publisher    
AIMS: Esophageal varices (EVs) are prevalent among cirrhotics and their bleeding leads to substantial morbidity and mortality. Management guidelines available during this study recommended beta-blocker therapy for primary prophylaxis and beta-blocker or band ligation (EVL) for secondary prophylaxis. We evaluated prophylaxis practice patterns. METHODS: We performed a retrospective cohort study of in and outpatient cirrhotics with known EVs at two University of Texas Southwestern teaching institutions. Use of prophylactic therapy and its adequacy (defined using published guidelines) was measured. RESULTS: A total of 419 patients with cirrhosis and EVs warranting prophylaxis were identified, including 276 inpatients and 143 outpatients. Of those admitted with a first bleed (i.e. eligible for primary prophylactic therapy), 30/104 (29%) were on beta blocker. In this group, only 3/104 (3%) received optimal therapy (heart rate <55). Among inpatients with a previous EV bleed, 120/172 (70%) were on a beta blocker or had undergone EVL, although only 66/172 (38%) received optimal therapy. In the inpatient cohort, ten patients died of gastrointestinal hemorrhage, three of whom were receiving optimal therapy. Among outpatients, 94/121 (78%) without previous bleeding received primary prophylaxis and 20/22 (91%) of those with previous bleeding received some form of secondary prophylaxis. However, only 11 (9%) received adequate primary prophylaxis therapy, while 9 (41%) received appropriate secondary prophylaxis. CONCLUSIONS: Prophylaxis intent appears to be greatly improved compared to previous reports. However, implementation of optimal therapy appeared to be suboptimal. We conclude that efforts need to be made to ensure optimal treatment.
Haripriya Maddur; Suraj Naik; Ali A Siddiqui; Don C Rockey
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-26
Journal Detail:
Title:  Digestive diseases and sciences     Volume:  -     ISSN:  1573-2568     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7902782     Medline TA:  Dig Dis Sci     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8887, USA.
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