Effectiveness of doubling the daily dose of Proton pump inhibitors in Preventing Stress Ulcer Bleeding in Perioperative Patients with Risk Factors: A Propensity Score - Matched Cohort Study

Objective: Non-critically ill perioperative patients exhibit lower gastrointestinal bleeding risks with more controllable risk factors than critically ill patients. However, the specific preventive medication design of proton pump inhibitors (PPIs) still requires more support. The aim of this study is to investigate whether mild patients with risk factors for concomitant medication can improve the prevention of gastrointestinal bleeding by increasing the frequency of administration. Methods: This study is a single-center, retrospective study through propensity score - matched cohort. From August 2022 to December 2023, we screened 1,057 patients using lansoprazole for injection with risk factors for developing stress ulcers. The postoperative changes in hemoglobin levels were employed to evaluate the severity of gastrointestinal hemorrhage following the exclusion of other potential etiologies contributing to bleeding. Results: Overall, dose escalation demonstrated a marginal association with reduced postoperative ulcer-related gastrointestinal bleeding (odds ratio [OR] 1.385; 95% confidence interval [CI], 0.76–2.52; p < 0.05). In subgroup analyses, younger patients (<65 years) (OR 2.463; 95% CI, 1.128–5.378; p < 0.05), and those without anticoagulant/antiplatelet therapy (AA) (OR 1.813; 95% CI, 0.796–4.128; p < 0.05) showed a potential and enhanced therapeutic response. Conclusions: The dosing frequency of PPIs may improve the prophylactic efficacy against gastrointestinal bleeding. However, it is not reasonable to draw a conclusion that some combination of drugs will prioritize and directly increase the risk of gastrointestinal bleeding. For non-severe patients, the comprehensive risk assessment for ulcer development is methodologically more rigorous than relying exclusively on concomitant medication evaluation. Dear Editor： On behalf of all authors, I would like to ask you to consider our manuscript entitled “Effectiveness of doubling the daily dose of Proton pump inhibitors in Preventing Stress Ulcer Bleeding in Perioperative Patients with Risk Factors: A Propensity Score - Matched Cohort Study” for publication in The British Journal of Clinical Pharmacology. The perioperative prevention of peptic ulcers and stress ulcer bleeding constitutes a principal clinical indication for proton pump inhibitors (PPIs). Our study aims to evaluate the efficacy of PPI prophylaxis and standardise its clinical implementation. Through observational practice, we note that clinicians tend to prescribe PPIs pre-emptively, primarily to mitigate potential postoperative complications such as prolonged fasting or impaired recovery associated with gastrointestinal bleeding. Nevertheless, substantial ambiguity remains regarding optimal daily dosing and treatment duration in these scenarios. While the clinical benefits of PPIs are well established, their long-term use presents a double-edged sword. While the clinical benefits of PPIs are well established, their long-term use presents a double-edged sword. Emerging evidence links PPI administration in critically ill patients to clinically significant outcomes including 30-day mortality, pulmonary infections, and hypomagnesaemia. Paradoxically, prescribing patterns for non-critical patients appear less rigorously scrutinised. Our routine practice audits indicate that PPI selection and dosing schedules may be influenced by prescriber preference and institutional drug formularies, potentially introducing subjective variability into treatment protocols. Therefore, this study aims to investigate whether concomitant medication use influences prophylactic dosing regimens for gastrointestinal bleeding in non-critical patients. We will systematically collect clinical data from this cohort and conduct comparative analyses of postoperative bleeding outcomes to clarify these pharmacological interactions. In this study, we selected patients undergoing orthopedic surgery as the study cohort, as this population possesses specific characteristics advantageous for our research design. These patients often require long-term maintenance medications (e.g., anticoagulants/antiplatelet agents, NSAIDs, or corticosteroids), which are recognized risk factors for drug-induced gastrointestinal bleeding. We specifically chose lansoprazole as the target prophylactic agent due to its frequent prescription patterns in this setting. After applying strict inclusion criteria, patients were matched using propensity scores. Subsequent comparative analysis of postoperative gastrointestinal bleeding outcomes was conducted to investigate the relationship between increased PPI dosages and clinical benefits. Thanks for your time and help. Yours Sincerely, BI LI Information & Authors Information Version history Copyright This work is licensed under a Non Exclusive No Reuse License.

Authors Metrics & Citations Metrics Article Usage 192views 163downloads Citations Download citation BI LI, Wei Wei, Xiaoxuan Zhang, et al. Effectiveness of doubling the daily dose of Proton pump inhibitors in Preventing Stress Ulcer Bleeding in Perioperative Patients with Risk Factors: A Propensity Score - Matched Cohort Study. Authorea. 16 May 2025. DOI: https://doi.org/10.22541/au.174742034.43608493/v1 DOI: https://doi.org/10.22541/au.174742034.43608493/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu.