Assessment of clinical practice of secondary prophylaxis for varceal bleeding and prevalence of recurrence, among adult patients in TikurAnbesa Specialized Hospital, in Addis Ababa, Ethiopia, 2020.
No Thumbnail Available
Date
2020-12
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Abeba University
Abstract
Background: - Variceal bleeding refers to bleeding due to rupture of varix which is usually
found in the esophagus or stomach. Recurrent variceal bleeding is a bleeding episode that occurs
after 5
th
day of initial episode. The approaches to patients who have had first variceal bleeding is
controlling the acute bleeding and prevent further re-bleeding. To prevent re-bleeding and
mortality, secondary prophylaxis is indicated for all patients. This usually requires repeated
variceal band ligation until varices are obliterated and/or nonselective Beta blocker. Failure to
apply guideline based clinical practice of secondary prophylaxis will predispose to increased risk
of recurrent variceal bleeding, hospitalization and mortality. There is no published data
regarding clinical practice of secondary prophylaxis for variceal bleeding and prevalence of
recurrence in Ethiopian context.
Objective: - To assess the clinical practice of secondary prophylaxis for variceal bleeding and
prevalence of recurrence among adult patients in Tikur Anbesa Specialized Hospital, in Addis
Ababa, Ethiopia, 2015-2019.
Methods: - A hospital based cross-sectional study was conducted on 140 adults who had
endoscopically confirmed variceal bleeding during 2015-2019. Retrospective data from hospital
records including socio-demographic characteristics, clinical and laboratory data and endoscopic
results of the patients were collected. EpiData version 4.4.2.1 software was used for data entry
and STATA15.1 for analysis. Descriptive data were presented as mean, percentage and standard
deviations.
Result: - Propranolol was the main medical treatment given as secondary prophylaxis.
Propranolol (96.4%), EVL & propranolol (2.9%), and carvidelol (0.7%) were started before or at
discharge. Of these patients 9.4%, 11.5%, 20.2% and 28.6% achieved the guide line
recommended target heart rate at 2-6 week, 6 week-3 month, 3 month-6 month, and 6 month- 1
year respectively on follow up. More than 70% of the pat ients’ heart rate is not in the target rate
in each follow up. 61.2%, 65.8%, 53.6%, 69% patients had their dose of propranolol adjusted at
each consecutive follow up. Significant proportion of patients, 38.8%, 34.2%, 46.4%, & 31%
were not provided with the appropriate dose adjustment. Of the patients who were on follow up
11.5% had experienced recurrence of variceal bleeding. Conclusion and recommendation:-There was a significant gap in clinical practice of guideline
recommended secondary prophylaxis for the prevention of variceal rebleeding in patients on
follow up in TASH during the study period. There was lack of continuous supply of EVL bands
in the country and appropriate escalation of the dose of propranolol was not implemented as per
guideline recommendations in significant proportion of patient. Physicians should follow the
appropriate evidence based guidelines in the management of variceal bleeding and prevention of
rebleeding. Furthermore the hospital should avail necessary supplies like EVL which are vital for
endoscopic intervention to control acute bleeding and for prevention of rebleeding.
Description
Keywords
Prophylaxis, varceal bleeding , adult patients