Pharmacological interventions for preventing upper
gastrointestinal bleeding in people admitted to intensive care
units: a network meta-analysis

J 2024

Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis

TOEWS, Ingrid, Mohammad Salman HUSSAIN, John L Z NYIRENDA, Maria A WILLIS, Lucia HASONOVÁ et. al.

Basic information

Original name

Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis

Authors

Edition

BMJ EVIDENCE-BASED MEDICINE, London, BMJ PUBLISHING GROUP, 2024, 2515-446X

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 5.800 in 2022

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1136/bmjebm-2024-112886

UT WoS

001270955700001

Keywords in English

Systematic Reviews as Topic; Drug-Related Side Effects and Adverse Reactions; Gastrointestinal Diseases; Hematology

Abstract

V originále

Objectives To assess the efficacy and safety of pharmacological interventions for preventing upper gastrointestinal (GI) bleeding in people admitted to intensive care units (ICUs).Design and setting Systematic review and frequentist network meta-analysis using standard methodological procedures as recommended by Cochrane for screening of records, data extraction and analysis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence.Participants Randomised controlled trials involving patients admitted to ICUs for longer than 24 hours were included.Search methods The Cochrane Gut Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Latin American and Caribbean Health Science Information database (LILACS) databases were searched from August 2017 to March 2022. The search in MEDLINE was updated in April 2023. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP).Main outcome measures The primary outcome was the prevention of clinically important upper GI bleeding.Results We included 123 studies with 46 996 participants. Cimetidine (relative risk (RR) 0.56, 95% CI 0.40 to 0.77, moderate certainty), ranitidine (RR 0.54, 95% CI 0.38 to 0.76, moderate certainty), antacids (RR 0.48, 95% CI 0.33 to 0.68, moderate certainty), sucralfate (RR 0.54, 95% CI 0.39 to 0.75, moderate certainty) and a combination of ranitidine and antacids (RR 0.13, 95% CI 0.03 to 0.62, moderate certainty) are likely effective in preventing upper GI bleeding. The effect of any intervention on the prevention of nosocomial pneumonia, all-cause mortality in the ICU or the hospital, duration of the stay in the ICU, duration of intubation and (serious) adverse events remains unclear.Results We included 123 studies with 46 996 participants. Cimetidine (relative risk (RR) 0.56, 95% CI 0.40 to 0.77, moderate certainty), ranitidine (RR 0.54, 95% CI 0.38 to 0.76, moderate certainty), antacids (RR 0.48, 95% CI 0.33 to 0.68, moderate certainty), sucralfate (RR 0.54, 95% CI 0.39 to 0.75, moderate certainty) and a combination of ranitidine and antacids (RR 0.13, 95% CI 0.03 to 0.62, moderate certainty) are likely effective in preventing upper GI bleeding. The effect of any intervention on the prevention of nosocomial pneumonia, all-cause mortality in the ICU or the hospital, duration of the stay in the ICU, duration of intubation and (serious) adverse events remains unclear.Conclusions Several interventions seem effective in preventing clinically important upper GI bleeding while there is limited evidence for other outcomes. Patient-relevant benefits and harms need to be assessed under consideration of the patients' underlying conditions.

Citovat

TOEWS, Ingrid, Mohammad Salman HUSSAIN, John L Z NYIRENDA, Maria A WILLIS, Lucia HASONOVÁ, Simona SLEZAKOVA, Minyahil Tadesse BOLTENA, Peter John VICTOR, Luis Eduardo Santos FONTES, Miloslav KLUGAR, Behnam SADEGHIRAD and Joerg J MEERPOHL. Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis. BMJ EVIDENCE-BASED MEDICINE. London: BMJ PUBLISHING GROUP, 2024, 14 pp. ISSN 2515-446X. Available from: https://dx.doi.org/10.1136/bmjebm-2024-112886.

@article{2421663,
   author = {Toews, Ingrid and Hussain, Mohammad Salman and Nyirenda, John L Z and Willis, Maria A and Hasonová, Lucia and Slezakova, Simona and Boltena, Minyahil Tadesse and Victor, Peter John and Fontes, Luis Eduardo Santos and Klugar, Miloslav and Sadeghirad, Behnam and Meerpohl, Joerg J},
   article_location = {London},
   doi = {http://dx.doi.org/10.1136/bmjebm-2024-112886},
   keywords = {Systematic Reviews as Topic; Drug-Related Side Effects and Adverse Reactions; Gastrointestinal Diseases; Hematology},
   language = {eng},
   issn = {2515-446X},
   journal = {BMJ EVIDENCE-BASED MEDICINE},
   title = {Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis},
   url = {https://ebm.bmj.com/content/early/2024/07/26/bmjebm-2024-112886},
   year = {2024}
}

TY  - JOUR
ID  - 2421663
AU  - Toews, Ingrid - Hussain, Mohammad Salman - Nyirenda, John L Z - Willis, Maria A - Hasonová, Lucia - Slezakova, Simona - Boltena, Minyahil Tadesse - Victor, Peter John - Fontes, Luis Eduardo Santos - Klugar, Miloslav - Sadeghirad, Behnam - Meerpohl, Joerg J
PY  - 2024
TI  - Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis
JF  - BMJ EVIDENCE-BASED MEDICINE
PB  - BMJ PUBLISHING GROUP
SN  - 2515446X
KW  - Systematic Reviews as Topic
KW  - Drug-Related Side Effects and Adverse Reactions
KW  - Gastrointestinal Diseases
KW  - Hematology
UR  - https://ebm.bmj.com/content/early/2024/07/26/bmjebm-2024-112886
N2  - Objectives To assess the efficacy and safety of pharmacological interventions for preventing upper gastrointestinal (GI) bleeding in people admitted to intensive care units (ICUs).Design and setting Systematic review and frequentist network meta-analysis using standard methodological procedures as recommended by Cochrane for screening of records, data extraction and analysis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence.Participants Randomised controlled trials involving patients admitted to ICUs for longer than 24 hours were included.Search methods The Cochrane Gut Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Latin American and Caribbean Health Science Information database (LILACS) databases were searched from August 2017 to March 2022. The search in MEDLINE was updated in April 2023. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP).Main outcome measures The primary outcome was the prevention of clinically important upper GI bleeding.Results We included 123 studies with 46 996 participants. Cimetidine (relative risk (RR) 0.56, 95% CI 0.40 to 0.77, moderate certainty), ranitidine (RR 0.54, 95% CI 0.38 to 0.76, moderate certainty), antacids (RR 0.48, 95% CI 0.33 to 0.68, moderate certainty), sucralfate (RR 0.54, 95% CI 0.39 to 0.75, moderate certainty) and a combination of ranitidine and antacids (RR 0.13, 95% CI 0.03 to 0.62, moderate certainty) are likely effective in preventing upper GI bleeding. The effect of any intervention on the prevention of nosocomial pneumonia, all-cause mortality in the ICU or the hospital, duration of the stay in the ICU, duration of intubation and (serious) adverse events remains unclear.Results We included 123 studies with 46 996 participants. Cimetidine (relative risk (RR) 0.56, 95% CI 0.40 to 0.77, moderate certainty), ranitidine (RR 0.54, 95% CI 0.38 to 0.76, moderate certainty), antacids (RR 0.48, 95% CI 0.33 to 0.68, moderate certainty), sucralfate (RR 0.54, 95% CI 0.39 to 0.75, moderate certainty) and a combination of ranitidine and antacids (RR 0.13, 95% CI 0.03 to 0.62, moderate certainty) are likely effective in preventing upper GI bleeding. The effect of any intervention on the prevention of nosocomial pneumonia, all-cause mortality in the ICU or the hospital, duration of the stay in the ICU, duration of intubation and (serious) adverse events remains unclear.Conclusions Several interventions seem effective in preventing clinically important upper GI bleeding while there is limited evidence for other outcomes. Patient-relevant benefits and harms need to be assessed under consideration of the patients' underlying conditions.
ER  -

TOEWS, Ingrid, Mohammad Salman HUSSAIN, John L Z NYIRENDA, Maria A WILLIS, Lucia HASONOVÁ, Simona SLEZAKOVA, Minyahil Tadesse BOLTENA, Peter John VICTOR, Luis Eduardo Santos FONTES, Miloslav KLUGAR, Behnam SADEGHIRAD and Joerg J MEERPOHL. Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis. \textit{BMJ EVIDENCE-BASED MEDICINE}. London: BMJ PUBLISHING GROUP, 2024, 14 pp. ISSN~2515-446X. Available from: https://dx.doi.org/10.1136/bmjebm-2024-112886.

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