Journal of Thrombosis and Thrombolysis

, Volume 28, Issue 3, pp 282–287

Early use of omeprazole benefits patients with acute myocardial infarction

  • Qian-Ping Gao
  • Yan Sun
  • Yu-Xue Sun
  • Lan-Feng Wang
  • Lu Fu
Article
  • 133 Downloads

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.

Keywords

Acute myocardial infarction Omeprazole Upper gastrointestinal bleeding Mortality Recanalization 

References

  1. 1.
    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 PubMedCrossRefGoogle Scholar
  2. 2.
    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 PubMedCrossRefGoogle Scholar
  3. 3.
    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 PubMedCrossRefGoogle Scholar
  4. 4.
    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 PubMedCrossRefGoogle Scholar
  5. 5.
    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 PubMedCrossRefGoogle Scholar
  6. 6.
    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 PubMedCrossRefGoogle Scholar
  7. 7.
    Demertzis K, Polymeros D, Emmanuel T et al (2006) Omeprazole maintenance therapy prevents recurrent ulcer bleeding after surgery for duodenal ulcer. World J Gastroenterol 12:791–795PubMedGoogle Scholar
  8. 8.
    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 PubMedCrossRefGoogle Scholar
  9. 9.
    Coursol CJ, Sanzari SE (2005) Impact of stress ulcer prophylaxis algorithm study. Ann Pharmacother 39:810–816. doi:10.1345/aph.1D129 PubMedCrossRefGoogle Scholar
  10. 10.
    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 PubMedCrossRefGoogle Scholar
  11. 11.
    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 PubMedCrossRefGoogle Scholar
  12. 12.
    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 PubMedCrossRefGoogle Scholar
  13. 13.
    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 PubMedCrossRefGoogle Scholar
  14. 14.
    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 PubMedCrossRefGoogle Scholar
  15. 15.
    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 PubMedCrossRefGoogle Scholar
  16. 16.
    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 CrossRefGoogle Scholar
  17. 17.
    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 PubMedCrossRefGoogle Scholar
  18. 18.
    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 PubMedCrossRefGoogle Scholar
  19. 19.
    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 PubMedCrossRefGoogle Scholar
  20. 20.
    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 PubMedCrossRefGoogle Scholar
  21. 21.
    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 PubMedCrossRefGoogle Scholar
  22. 22.
    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 PubMedCrossRefGoogle Scholar
  23. 23.
    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 100:1016–1030PubMedGoogle Scholar
  24. 24.
    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 PubMedCrossRefGoogle Scholar
  25. 25.
    Toporan D (1996) Acute myocardial infarction and acute “stress ulcer”. Rom J Intern Med 34:211–215PubMedGoogle Scholar
  26. 26.
    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 PubMedCrossRefGoogle Scholar
  27. 27.
    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 PubMedCrossRefGoogle Scholar
  28. 28.
    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 PubMedCrossRefGoogle Scholar
  29. 29.
    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 PubMedCrossRefGoogle Scholar
  30. 30.
    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 PubMedCrossRefGoogle Scholar
  31. 31.
    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–RA209PubMedGoogle Scholar
  32. 32.
    Harty RF, Ancha HB (2006) Stress ulcer bleeding. Curr Treat Options Gastroenterol 9:157–166. doi:10.1007/s11938-006-0034-3 PubMedCrossRefGoogle Scholar
  33. 33.
    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–G804PubMedGoogle Scholar
  34. 34.
    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 PubMedCrossRefGoogle Scholar
  35. 35.
    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 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Qian-Ping Gao
    • 1
  • Yan Sun
    • 2
  • Yu-Xue Sun
    • 3
  • Lan-Feng Wang
    • 1
  • Lu Fu
    • 1
  1. 1.Department of CardiologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
  2. 2.Department of General SurgeryThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
  3. 3.Department of EmergencyThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina

Personalised recommendations