Abstract
Background Bleeding complications are not uncommon in patients with acute myocardial infarction (AMI) during treatments. How to prevent the occurrence of upper gastrointestinal bleeding in AMI patients has become one of the most intractable problems. And there are conflicting data on the efficacy and complication rate of omeprazole treatment. We conducted an intervention study to determine whether using omeprazole could benefit AMI patients. Methods A total of 237 patients with AMI were divided into two groups at random: omeprazole group including 114 patients and control group including 123 patients. Omeprazole 40 mg by intravenous drip was given to the patients in omeprazole group when they were admitted to the hospitals. From the second day they were given omeprazole 20 mg per day by oral administration for 7 days. In contrast, no gastric acid inhibitor was given to the patients in control group. The incidence of upper gastrointestinal bleeding, the recanalization rate and overall mortality in both groups were observed. Results The incidence of upper gastrointestinal bleeding in omeprazole group was 5.3% (6/114) which was much lower than 14.6% (18/123) in control group (P = 0.017), but the recanalization rate had no significant difference between the two groups (P = 0.681). The overall mortality in omeprazole group was lower than that of control group (3.5% vs. 10.6%, P = 0.035). Conclusions Our findings suggest that early use of omeprazole in AMI patients could decrease the incidence of upper gastrointestinal bleeding and the overall mortality, without influencing the recanalization rate. Early use of omeprazole might benefit AMI patients.
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Ibanez L, Vidal X, Vendrell L et al (2006) Upper gastrointestinal bleeding associated with antiplatelet drugs. Aliment Pharmacol Ther 23:235–242. doi:10.1111/j.1365-2036.2006.02759.x
Al-Mallah M, Bazari RN, Jankowski M et al (2007) Predictors and outcomes associated with gastrointestinal bleeding in patients with acute coronary syndromes. J Thromb Thrombolysis 23:51–55. doi:10.1007/s11239-006-9005-8
Eikelboom JW, Mehta SR, Anand SS et al (2006) Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation 114:774–782. doi:10.1161/CIRCULATIONAHA.106.612812
Rao SV, O’Grady K, Pieper KS et al (2005) Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes. Am J Cardiol 96:1200–1206. doi:10.1016/j.amjcard.2005.06.056
Kaviani MJ, Hashemi MR, Kazemifar AR et al (2003) Effect of oral omeprazole in reducing re-bleeding in bleeding peptic ulcers: a prospective, double-blind, randomized, clinical trial. Aliment Pharmacol Ther 17:211–216. doi:10.1046/j.1365-2036.2003.01416.x
Lin HJ, Lo WC, Cheng YC et al (2006) Role of intravenous omeprazole in patients with high-risk peptic ulcer bleeding after successful endoscopic epinephrine injection: a prospective randomized comparative trial. Am J Gastroenterol 101:500–505. doi:10.1111/j.1572-0241.2006.00399.x
Demertzis K, Polymeros D, Emmanuel T et al (2006) Omeprazole maintenance therapy prevents recurrent ulcer bleeding after surgery for duodenal ulcer. World J Gastroenterol 12:791–795
Conrad SA, Gabrielli A, Margolis B et al (2005) Randomized, double-blind comparison of immediate-release omeprazole oral suspension versus intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients. Crit Care Med 33:760–765. doi:10.1097/01.CCM.0000157751.92249.32
Coursol CJ, Sanzari SE (2005) Impact of stress ulcer prophylaxis algorithm study. Ann Pharmacother 39:810–816. doi:10.1345/aph.1D129
Yang YX, Lewis JD, Epstein S et al (2006) Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 296:2947–2953. doi:10.1001/jama.296.24.2947
Laheij RJ, Sturkenboom MC, Hassing RJ et al (2004) Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA 292:1955–1960. doi:10.1001/jama.292.16.1955
Gulmez SE, Holm A, Frederiksen H et al (2007) Use of proton pump inhibitors and the risk of community-acquired pneumonia: a population-based case-control study. Arch Intern Med 167:950–955. doi:10.1001/archinte.167.9.950
Gilard M, Arnaud B, Cornily JC et al (2008) Influence of omeprazole on the antiplatelet action of clopidogrel associated with aspirin: the randomized, double-blind OCLA (Omeprazole CLopidogrel Aspirin) study. J Am Coll Cardiol 51:256–260. doi:10.1016/j.jacc.2007.06.064
Singh G, Triadafilopoulos G (2005) Appropriate choice of proton pump inhibitor therapy in the prevention and management of NSAID-related gastrointestinal damage. Int J Clin Pract 59:1210–1217. doi:10.1111/j.1368-5031.2005.00660.x
Abbas AE, Brodie B, Dixon S et al (2005) Incidence and prognostic impact of gastrointestinal bleeding after percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol 96:173–176. doi:10.1016/j.amjcard.2005.03.038
Lichtman JH, Spertus JA, Reid KJ et al (2007) Acute noncardiac conditions and in-hospital mortality in patients with acute myocardial infarction. Circulation 23(116):1925–1930. doi:10.1161/CIRCULATIONAHA.107.722090
Moscucci M, Fox KA, Cannon CP et al (2003) Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE). Eur Heart J 24:1815–1823. doi:10.1016/S0195-668X(03)00485-8
Yusuf S, Mehta SR, Chrolavicius S et al (2006) Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med 354:1464–1476. doi:10.1056/NEJMoa055443
Cohen M (2005) Predictors of bleeding risk and long-term mortality in patients with acute coronary syndromes. Curr Med Res Opin 21:439–445. doi:10.1185/030079905X30725
Weisman SM, Graham DY (2002) Evaluation of the benefits and risks of low-dose aspirin in the secondary prevention of cardiovascular and cerebrovascular events. Arch Intern Med 162:2197–2202. doi:10.1001/archinte.162.19.2197
Hernandez-Diaz S, Rodriguez LA (2000) Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: an overview of epidemiologic studies published in the 1990s. Arch Intern Med 160:2093–2099. doi:10.1001/archinte.160.14.2093
Aalykke C, Lauritsen K (2001) Epidemiology of NSAID-related gastroduodenal mucosal injury. Best Pract Res Clin Gastroenterol 15:705–722. doi:10.1053/bega.2001.0230
Ryan TJ, Antman EM, Brooks NH et al (1999) 1999 Update: ACC/AHA Guidelines for the Management of Patients With Acute Myocardial Infarction: Executive Summary and Recommendations: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation 100:1016–1030
Antman EM, Anbe DT, Armstrong PW et al (2004) ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation 110:588–636. doi:10.1161/01.CIR.0000134791.68010.FA
Toporan D (1996) Acute myocardial infarction and acute “stress ulcer”. Rom J Intern Med 34:211–215
Motivala AA, Tamhane U, Saab F et al (2007) Temporal trends in antiplatelet/antithrombotic use in acute coronary syndromes and in-hospital major bleeding complications. Am J Cardiol 100(9):1359–1363. doi:10.1016/j.amjcard.2007.06.023
Lim MJ, Eagle KA, Gore JM et al (2005) Treating patients with acute coronary syndromes with aggressive antiplatelet therapy (from the Global Registry of Acute Coronary Events). Am J Cardiol 96:917–921. doi:10.1016/j.amjcard.2005.05.047
Stollman N, Metz DC (2005) Pathophysiology and prophylaxis of stress ulcer in intensive care unit patients. J Crit Care 20:35–45. doi:10.1016/j.jcrc.2004.10.003
Fennerty MB (2002) Pathophysiology of the upper gastrointestinal tract in the critically ill patient: rationale for the therapeutic benefits of acid suppression. Crit Care Med 30:S351–S355. doi:10.1097/00003246-200206001-00002
Gum PA, Thamilarasan M, Watanabe J et al (2001) Aspirin use and all-cause mortality among patients being evaluated for known or suspected coronary artery disease: a propensity analysis. JAMA 286:1187–1194. doi:10.1001/jama.286.10.1187
Konturek PC, Konturek SJ, Czesnikiewicz M et al (2002) Interaction of Helicobacter pylori (Hp) and nonsteroidal anti-inflammatory drugs (NSAID) on gastric mucosa and risk of ulcerations. Med Sci Monit 8:RA197–RA209
Harty RF, Ancha HB (2006) Stress ulcer bleeding. Curr Treat Options Gastroenterol 9:157–166. doi:10.1007/s11938-006-0034-3
Takehara Y, Sumii K, Tari A et al (1996) Evidence that endogenous GRP in rat stomach mediates omeprazole-induced hypergastrinemia. Am J Physiol 271:G799–G804
Hawkey CJ, Karrasch JA, Szczepanski L et al (1998) Omeprazole compared with misoprostol for ulcers associated with nonsteroidal antiinflammatory drugs. Omeprazole versus Misoprostol for NSAID-induced Ulcer Management (OMNIUM) Study Group. N Engl J Med 338:727–734. doi:10.1056/NEJM199803123381105
Khuroo MS, Khuroo MS, Farahat KL et al (2005) Treatment with proton pump inhibitors in acute non-variceal upper gastrointestinal bleeding: a meta-analysis. J Gastroenterol Hepatol 20:11–25. doi:10.1111/j.1440-1746.2004.03441.x
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Gao, QP., Sun, Y., Sun, YX. et al. Early use of omeprazole benefits patients with acute myocardial infarction. J Thromb Thrombolysis 28, 282–287 (2009). https://doi.org/10.1007/s11239-008-0282-2
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DOI: https://doi.org/10.1007/s11239-008-0282-2