Use of GI ppx in acute strokes

[Neurologo]

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GI bleed in acute stroke is a significant risk and H2RBs or PPIs are often used acutely. Thanks to their use, incidence of GI bleeds has been going down to a very low rate as of 2015. They were automatically provided at my residency as is the case in many other major stroke centers. A non-neurology trained critical care doc is refusing to use them citing the suspected risk w/ C diff. This link has not been firmly confirmed, I believe. What is your view on this?

Greatly appreciate your input.

 

[typhoonegator]

If they're NPO, then I use a PPI. Once they're eating, it comes off. Basically, if their stroke is small enough that they can safely eat in the acute period, it probably isn't bad enough to cause gastric erosion/stress ulcer formation. Everyone else is NPO until they get an SLP evaluation and/or get tube feeds going. Those folks get themselves a PPI for at least a day or two.

The PPI/H2B link with C. diff has been best investigated in the pediatric population, and there appears to be a link. From my perspective, at least, the present data wouldn't be enough to keep them off a PPI in the acute setting.

 

[Neurologo]

That is how I see this issue as well. Thank you for sharing.

 

[caelum7]

At our CSC we do not routinely prophylax against stress ulcers for patients admitted to the floor with acute stroke; retrospective observational studies cite the risk to be quite low among those without prior history of ulcers, and it's not in any of the acute stroke guidelines (that I'm aware of). We also avoid H2 blockers in neuro patients for theoretical risk of H1 blockade CNS effects.