Multicenter hospital study on prescribing patterns for prophylaxis and treatment of complications of cirrhosis

Objective: To describe the prescribing patterns for liver disease management. Methods: A multicenter cross-sectional prospective observational study was carried out in 25 Spanish hospitals. Inpatients, admitted to gastrointestinal and liver units with a diagnosis of liver cirrhosis, were included in five centrally assigned index days between February and June 1999. Information was collected about demographic variables and pharmacological treatments used on admission and recommended at discharge. Results: Five hundred and sixty-eight patients (70% men, mean age 61 years) were studied. Alcoholic cirrhosis of the liver accounted for 44% of the sample, ascites being the most prevalent complication. The most frequent diuretic schedule on admission was the combination of spironolactone and furosemide at a ratio of I (100 mg/40 mg). Hospitalization resulted in an increase in the percentage of patients that received the combination at a ratio higher than 1. Diuretics were a major cause of adverse drug events on admission (7.5%). Ulcer-healing drugs showed a notable increase at discharge (35%; range 10-59%) compared with 24% (6-37%) on admission. Utilization rates at discharge were 65% (59-74%) for diuretics, 51% (38-76%) for laxatives, 31% (0-75%) for vitamin K, 24% (4-53%) for beta-adrenergic blocking agents, and 13% (0-47%) for nitrates, which were significantly higher than on admission. Conclusion: These results provide the first quantitative data of drug utilization in liver disease and highlight the wide variability in prescribing practices across centers and the higher than expected use of non-evidence-based treatments, especially vitamin K and antiulcer drugs.