UGI Bleed: Ranitidine reduces the risk compared to sucralfate
Clinical Bottom Line
In mechanically ventilated patients, the use of ranitidine compared with sucralfate reduces the risk of upper gastrointestinal bleeding.
Citation
Cook D, Guyatt G, Marshall J, et al. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation.
NEJM 1998;338:791-7
Clinical Question
In mechanically ventilated patients, does the use of ranitidine compared to sucralfate reduce the risk of upper gastrointestinal bleeding.
Search Terms
upper gastrointestinal bleed and ranitidine
The Study
- Double-blinded, concealed randomisation, controlled trial with intention to treat analysis. Mechanically ventilated medical and surgical patients.
- Control group (Sucralfate) N= 604, 604 analysed. Control group received ranitidine placebo. Neither group had Gastric pH checked.
- Experimental group (Ranitidine) N= 596, 596 analysed. Experimental group received sucralfate placebo.
The Evidence
| Outcome | Time to Outcome | CER | EER | RRR | ARR | NNT |
|---|---|---|---|---|---|---|
| UGI bleed | In hospital | 3.8% | 1.7% | 55% | 2.1% | 47 |
| 95% CI | 78% - 8% | 4% - 0.3% | 25 - 333 | |||
| Vent associate Pneumonia | In hospital | 16.2% | 19.1% | 18% increase | 2.9% increase | 34 additional pneumonias |
| 95% CI | 8% decrease to 51% increase | 1.4% decrease to 7.2% increase | 72 fewer to 14 additional |
Comments
Study population in included both medical and surgical adult mechanically ventilated patients.
Appraised By
Pronovost 1999
Expiry Date
2000