{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:03:51Z","timestamp":1787508231504,"version":"build-2736575974"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T00:00:00Z","timestamp":1618790400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T00:00:00Z","timestamp":1618790400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Patients with decompensated cirrhosis are prescribed numerous medications. Data are limited as to whether patients are receiving medications they need and avoiding those they do not. We examined a large national claims database (2010\u20102015) to characterize the complete medication profile as well as the factors associated with appropriate and potentially inappropriate medication use in 12,621 patients with decompensated cirrhosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Approach and Results<\/jats:title>\n                    <jats:p>Clinical guidelines and existing literature were used to determine appropriate and potentially inappropriate medications in decompensated cirrhosis. The total medication days\u2019 supply was calculated from pharmacy data and divided by the follow\u2010up period for each decompensation. Ascites was the most common (86.5%), followed by hepatic encephalopathy (HE; 37.8%), variceal bleeding (VB; 17.5%), hepatorenal syndrome (6.3%), and spontaneous bacterial peritonitis (SBP; 6.1%). For patients with ascites, 55.8% filled a diuretic. For patients with HE, 32.4% and 63.3% filled rifaximin and lactulose, respectively. After VB, 60.3% of patients filled a nonselective beta blocker, and after an episode of SBP, 48.0% of patients filled an antibiotic for prophylaxis. The minority (4.5%\u201017.3%) had enough medication to cover &gt;50% follow\u2010up days. Potentially inappropriate medication use was common: 53.2% filled an opiate, 46.0% proton pump inhibitors, 14.2% benzodiazepines, and 10.1% nonsteroidal anti\u2010inflammatory drugs. Disease severity markers were associated with more appropriate mediation use but not consistently associated with less inappropriate medication use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with decompensated cirrhosis are not filling indicated medications as often or as long as is recommended and are also filling medications that are potentially harmful. Future steps include integrating pharmacy records with medical records to obtain a complete medication list and counseling on medication use with patients at each visit.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hep.31548","type":"journal-article","created":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T03:25:53Z","timestamp":1600831553000},"page":"2429-2440","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":32,"title":["Appropriate and Potentially Inappropriate Medication Use in Decompensated Cirrhosis"],"prefix":"10.1097","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1505-9091","authenticated-orcid":false,"given":"Mary J.","family":"Thomson","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition,University of Minnesota,Minneapolis,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5811-6845","authenticated-orcid":false,"given":"Anna S. F.","family":"Lok","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,University of Michigan,Ann Arbor,MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0839-1515","authenticated-orcid":false,"given":"Elliot B.","family":"Tapper","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,University of Michigan,Ann Arbor,MI"},{"name":"Institute for Healthcare Policy and Innovation,University of Michigan,Ann Arbor,MI"},{"name":"Veterans Affairs Hospital,Ann Arbor,MI"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,4,19]]},"reference":[{"key":"hep31548-bib-0001-20250824","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1111\/liv.13892","article-title":"Optimizing medication management for patients with cirrhosis: evidence\u2010based strategies and their outcomes","volume":"38","year":"2018","journal-title":"Liver Int"},{"key":"hep31548-bib-0002-20250824","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1080\/17425255.2020.1702022","article-title":"Safe use of medication in patients with cirrhosis: pharmacokinetic and pharmacodynamic considerations","volume":"16","year":"2020","journal-title":"Expert Opin Drug Metab Toxicol"},{"key":"hep31548-bib-0003-20250824","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1002\/hep4.1334","article-title":"Medication\u2010related problems in outpatients with decompensated cirrhosis: opportunities for harm prevention","volume":"3","year":"2019","journal-title":"Hepatol Commun"},{"key":"hep31548-bib-0004-20250824","doi-asserted-by":"crossref","first-page":"2087","DOI":"10.1002\/hep.22853","article-title":"Management of adult patients with ascites due to cirrhosis: an update","volume":"49","year":"2009","journal-title":"Hepatology"},{"key":"hep31548-bib-0005-20250824","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1002\/hep.20066","article-title":"Management of adult patients with ascites due to cirrhosis","volume":"39","year":"2004","journal-title":"Hepatology"},{"key":"hep31548-bib-0006-20250824","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1002\/hep.27210","article-title":"Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver","volume":"60","year":"2014","journal-title":"Hepatology"},{"key":"hep31548-bib-0007-20250824","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1002\/hep.28906","article-title":"Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases","volume":"65","year":"2017","journal-title":"Hepatology"},{"key":"hep31548-bib-0008-20250824","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1002\/cld.711","article-title":"Pain management in patients with cirrhosis","volume":"11","year":"2018","journal-title":"Clin Liver Dis (Hoboken)"},{"key":"hep31548-bib-0009-20250824","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1002\/hep4.1425","article-title":"Incidence of and risk factors for hepatic encephalopathy in a population\u2010based cohort of Americans with cirrhosis","volume":"3","year":"2019","journal-title":"Hepatol Commun"},{"key":"hep31548-bib-0010-20250824","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1016\/j.cgh.2015.03.019","article-title":"Psychoactive medications increase the risk of falls and fall\u2010related injuries in hospitalized patients with cirrhosis","volume":"13","year":"2015","journal-title":"Clin Gastroenterol Hepatol"},{"key":"hep31548-bib-0011-20250824","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/apt.13858","article-title":"Chronic opioid use is associated with altered gut microbiota and predicts readmissions in patients with cirrhosis","volume":"45","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"key":"hep31548-bib-0012-20250824","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1111\/pme.12480","article-title":"Risk factors for serious prescription opioid\u2010related toxicity or overdose among Veterans Health Administration patients","volume":"15","year":"2014","journal-title":"Pain Med"},{"key":"hep31548-bib-0013-20250824","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1111\/j.1742-1241.2011.02650.x","article-title":"Association between proton pump inhibitors and spontaneous bacterial peritonitis in cirrhotic patients\u2014a systematic review and meta\u2010analysis","volume":"65","year":"2011","journal-title":"Int J Clin Pract"},{"key":"hep31548-bib-0014-20250824","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1038\/ajg.2009.615","article-title":"Clostridium difficile is associated with poor outcomes in patients with cirrhosis: a national and tertiary center perspective","volume":"105","year":"2010","journal-title":"Am J Gastroenterol"},{"key":"hep31548-bib-0015-20250824","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.amjmed.2015.12.006","article-title":"Preventing and treating acute kidney injury among hospitalized patients with cirrhosis and ascites: a narrative review","volume":"129","year":"2016","journal-title":"Am J Med"},{"key":"hep31548-bib-0016-20250824","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1111\/apt.14485","article-title":"Betablockers do not increase efficacy of band ligation in primary prophylaxis but they improve survival in secondary prophylaxis of variceal bleeding","volume":"47","year":"2018","journal-title":"Aliment Pharmacol Ther"},{"key":"hep31548-bib-0017-20250824","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1111\/apt.15265","article-title":"Targets to improve quality of care for patients with hepatic encephalopathy: data from a multi\u2010centre cohort","volume":"49","year":"2019","journal-title":"Aliment Pharmacol Ther"},{"key":"hep31548-bib-0019-20250824","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1002\/hep.30489","article-title":"Development of quality measures in cirrhosis by the Practice Metrics Committee of the American Association for the Study of Liver Diseases","volume":"69","year":"2019","journal-title":"Hepatology"},{"key":"hep31548-bib-0020-20250824","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1053\/j.gastro.2014.03.005","article-title":"Nonselective \u03b2 blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis","volume":"146","year":"2014","journal-title":"Gastroenterology"},{"key":"hep31548-bib-0021-20250824","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1002\/hep.26359","article-title":"Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012","volume":"57","year":"2013","journal-title":"Hepatology"},{"key":"hep31548-bib-0022-20250824","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s12876-016-0530-4","article-title":"Prevalence of medication discrepancies in patients with cirrhosis: a pilot study","volume":"16","year":"2016","journal-title":"BMC Gastroenterol"}],"container-title":["Hepatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fhep.31548","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hep.31548","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hep.31548","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/10.1002\/hep.31548","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:04:51Z","timestamp":1756080291000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1002\/hep.31548"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,19]]},"references-count":21,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1002\/hep.31548","relation":{},"ISSN":["0270-9139","1527-3350"],"issn-type":[{"value":"0270-9139","type":"print"},{"value":"1527-3350","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,19]]},"assertion":[{"value":"2020-03-29","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-13","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}