Journal Article

Esomeprazole Compared With Famotidine in the Prevention of Upper Gastrointestinal Bleeding in Patients With Acute Coronary Syndrome or Myocardial Infarction

Chu, Wai-Ming, Chan, Kit, Lau, Yuk-Kong, Lam, Kwok-Fai, Keung, K K, Kng, Carolyn, Ng, Fook-Hong, Tunggal, P, Li, Andrew, Kwan, Ambrose, Wong, Benjamin C Y

2012

Overview

Little is known about the efficacy of proton pump inhibitors compared with H(2) receptor antagonists in preventing adverse upper gastrointestinal complications in patients with acute coronary syndrome (ACS) or ST elevation myocardial infarction (STEMI) receiving aspirin, clopidogrel, and enoxaparin or thrombolytics. The objective of this study was to compare the efficacies of esomeprazole and famotidine in preventing gastrointestinal complications. A double-blind, randomized, controlled trial was performed in patients receiving a combination of aspirin, clopidogrel, and either enoxaparin or thrombolytics. Patients received either esomeprazole (20 mg nocte) or famotidine (40 mg nocte) orally for 4-52 weeks, depending on the duration of dual antiplatelet therapy. The primary end point was upper gastrointestinal bleeding (GIB), perforation, or obstruction from ulcer/erosion (http://www.clinicaltrials.gov NCT00683111). In all, 311 patients were recruited, with 163 and 148 patients in the esomeprazole and famotidine groups, respectively. Mean (s.d.) follow-up was 19.2 (17.6) and 17.6 (18.0) weeks, respectively. One (0.6%) patient in the esomeprazole group and 9 (6.1%) in the famotidine group reached the primary end point (log-rank test, P=0.0052, hazard ratio=0.095, 95% confidence interval: 0.005-0.504); all had upper GIB. In patients with ACS or STEMI, esomeprazole is superior to famotidine in preventing upper gastrointestinal complications related to aspirin, clopidogrel, and enoxaparin or thrombolytics.

• Publisher: Nature Publishing Group,Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subject: Acute Coronary Syndrome - complications / Acute Coronary Syndrome - drug therapy / Aged / Anti-Ulcer Agents - administration & dosage / Anti-Ulcer Agents - therapeutic use / Aspirin - administration & dosage / Aspirin - adverse effects / Biological and medical sciences / Cardiology. Vascular system / Chi-Square Distribution / Coronary heart disease / Digestive system / Double-Blind Method / Drug Therapy, Combination / Enoxaparin - administration & dosage / Enoxaparin - adverse effects / Esomeprazole - administration & dosage / Esomeprazole - therapeutic use / Famotidine - administration & dosage / Famotidine - therapeutic use / Female / Fibrinolytic Agents - administration & dosage / Fibrinolytic Agents - adverse effects / Follow-Up Studies / Gastroenterology / Gastroenterology. Liver. Pancreas. Abdomen / Gastrointestinal Hemorrhage - chemically induced / Gastrointestinal Hemorrhage - prevention & control / Heart / Humans / Intestinal Perforation - etiology / Intestinal Perforation - prevention & control / Male / Medical sciences / Middle Aged / Other diseases. Semiology / Pharmacology. Drug treatments / Platelet Aggregation Inhibitors - administration & dosage / Platelet Aggregation Inhibitors - adverse effects / Proportional Hazards Models / Stomach. Duodenum. Small intestine. Colon. Rectum. Anus / Ticlopidine - administration & dosage / Ticlopidine - adverse effects / Ticlopidine - analogs & derivatives / Treatment Outcome