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Background: Glucagon-like peptide-1 receptor agonists (GLP-1RA) have delayed gastric emptying properties; however, the impact on esophagogastroduodenoscopy (EGD) visualization is unknown., Objective: This study examines the impact of GLP-1RA use on EGD visualization and gastric content retention., Methods: This was a retrospective cohort study with matched controls. The primary endpoint was the odds of retained food documented during EGD. Secondary endpoints included incidence of lavage and need for repeat EGD due to poor visualization and were compared using Fisher exact test. Analyses were performed in R Studio., Results: There were 59 patients in the cohort prescribed a GLP-1RA with 118 matched controls. Food retention was documented with 4 patients (6.8%) in the GLP-1RA cohort versus 2 patients (1.7%) in the control group (odds ratio [OR] 4.22 [95% CI 0.87-20.34]). No difference was observed in the need for lavage during EGD or in the need for repeat EGD attributed to poor visualization., Conclusion and Relevance: This study addresses a previously uninvestigated question in clinical practice. GLP-1RA did not significantly increase odds of retained food on EGD. Although a numerical difference was observed, it did not reach statistical difference. No cases required repeat EGD due to poor visualization, and no change to EGD pre-procedure instructions were warranted at the study facility.

Objective: To report 2 cases of thrombocytopenia associated with pantoprazole treatment and discuss existing reports on this drug-induced adverse event., Case Summaries: This paper describes the course of thrombocytopenia associated with pantoprazole 40 mg in 2 hospitalized patients. In both cases, thrombocytopenia appeared after the initiation of pantoprazole and rapidly improved after discontinuation of pantoprazole, although complete resolution of thrombocytopenia occurred in only one patient prior to discharge from the hospital., Discussion: The mechanism of drug-induced thrombocytopenia is often poorly understood, and proton-pump inhibitors are generally not strongly suspected as a cause of thrombocytopenia. However, an objective causality assessment using the Naranjo probability scale revealed a probable relationship between thrombocytopenia and pantoprazole in both of the cases. It is unknown whether this is a class effect., Conclusions: Although drug-induced thrombocytopenia with pantoprazole appears to be rare, it represents a potentially severe adverse effect. This supports the judicious prescribing of pantoprazole and possibly other proton-pump inhibitors.

Background: The risk for venous thromboembolism (VTE) in medical patients is similar to that in moderate-risk surgery patients. Pharmacologic thromboprophylaxis is recommended for certain medical patients, but its use in clinical practice is unknown., Objective: To assess whether medically ill patients with established risk factors receive pharmacologic VTE prophylaxis and determine whether prescribed regimens are consistent with current evidence and published recommendations., Methods: A retrospective chart review of 100 patients admitted to a hospital medicine service was conducted. Patients who were >40 years of age and admitted for congestive heart failure, chronic obstructive pulmonary disease, or respiratory infection were considered appropriate candidates for VTE prophylaxis if they had no documented bleeding risk factors. Patients considered at increased risk of bleeding included those with documented uncontrolled hypertension, thrombocytopenia, coagulopathy, or recent gastrointestinal bleeding. Prescribed regimens were evaluated to determine whether they were consistent with regimens proven in clinical trials to be effective and safe., Results: Thirty-one percent of the patients with established VTE risk factors and no documented risk factors for bleeding were prescribed pharmacologic VTE prophylaxis. An established regimen was prescribed in only 19% of those receiving prophylaxis., Conclusions: There is significant underutilization of VTE prophylaxis in this patient population. Patients are not adequately assessed for bleeding risk factors, and a portion of prescribed regimens are not those that have been established in the literature. Expert consensus statements recommend that hospitals develop strategies to prevent VTE events in their patients. Strategies to improve patient screening and physicians' prescribing habits are needed.