Indications for stress ulcer prophylaxis in critically ill patients

Major risk factors (prophylaxis recommended)
Positive pressure ventilation > 48 hours, including extracorporeal life support
Coagulopathy (platelet count < 50 × 109/L, international normalized ratio > 1.5, activated partial thromboplastin time > 2 times normal)a
History of gastrointestinal ulceration or bleeding within past year
Acute traumatic brain or spinal cord injury
Major thermal injury (≥ 35% of total body surface area)
Minor risk factors (prophylaxis recommended if ≥ 2 minor criteria are present)
Intensive care unit stay > 1 week
Occult gastrointestinal bleeding for ≥ 6 days
Glucocorticoid therapy (> 250 mg of hydrocortisone or the equivalent)
Use of antiplatelet or nonsteroidal anti-inflammatory agents
Renal failure or renal replacement therapy
Hepatic failure
History of peptic ulcer disease
Extracorporeal life support
Organ transplantation
  • a Independent predictors of clinically important gastrointestinal bleeding in critically ill patients.

  • Based on information in references 3, 5, 6, 8, and 12.