PMID- 18277903
OWN - NLM
STAT- MEDLINE
DCOM- 20080701
LR  - 20131121
IS  - 0192-0790 (Print)
IS  - 0192-0790 (Linking)
VI  - 42
IP  - 4
DP  - 2008 Apr
TI  - Upper gastrointestinal bleeding in patients with acute coronary syndromes: 
      clinical predictors and prophylactic role of proton pump inhibitors.
PG  - 368-72
LID - 10.1097/MCG.0b013e31802e63ff [doi]
AB  - OBJECTIVES: To determine the risk and the clinical predictors of in-hospital 
      upper gastrointestinal (UGI) bleeding in patients with acute coronary syndromes 
      (ACS), and to study the prophylactic role of proton pump inhibitors (PPI) in this 
      setting. BACKGROUND: Patients with ACS are usually treated by a combination of 
      antiplatelet, antithrombotic and thrombolytic medications, thereby increasing the 
      risk of bleeding. STUDY: A retrospective study of 1023 patients hospitalized with 
      ACS at the American University of Beirut Medical Center from September 2001 to 
      November 2005. The main outcome measurements were the incidence of in-hospital 
      UGI bleeding and its predictors; the utilization rate of PPI and its 
      determinants. RESULTS: Seven patients developed in-hospital UGI bleeding (0.7%) 
      and 2 had major bleeding (0.2%). All required blood transfusion and none died in 
      the hospital. Significant predictors of UGI bleeding were prior history of UGI 
      bleeding or peptic ulcer disease (P<0.01), creatinine > 2 mg/dL (P=0.01), and 
      home intake of aspirin, clopidogrel (P<0.05), or nonsteroidal anti-inflammatory 
      drugs (P<0.05). Sixty-nine percent of patients received PPI during their hospital 
      stay. There was no significant difference in the incidence of UGI bleeding 
      between patients receiving and those not receiving PPI (0.7% vs. 0.6%, P= 0.88). 
      CONCLUSIONS: The risk of UGI bleeding is relatively low in patients hospitalized 
      with ACS and does not appear to be significantly reduced by the use of PPI. The 
      utilization rate of PPI was relatively high. Better patient selection and risk 
      stratification for the prophylactic use of PPI are warranted.
FAU - Barada, Kassem
AU  - Barada K
AD  - Department of Internal Medicine, American University of Beirut, Lebanon.
FAU - Karrowni, Wassef
AU  - Karrowni W
FAU - Abdallah, Mouhamad
AU  - Abdallah M
FAU - Shamseddeen, Wael
AU  - Shamseddeen W
FAU - Sharara, Ala I
AU  - Sharara AI
FAU - Dakik, Habib A
AU  - Dakik HA
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - J Clin Gastroenterol
JT  - Journal of clinical gastroenterology
JID - 7910017
RN  - 0 (2-Pyridinylmethylsulfinylbenzimidazoles)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Proton Pump Inhibitors)
RN  - 32828355LL (Rabeprazole)
RN  - EC 3.6.3.14 (Proton-Translocating ATPases)
RN  - KG60484QX9 (Omeprazole)
SB  - IM
MH  - 2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use
MH  - Acute Coronary Syndrome/*complications/drug therapy
MH  - Aged
MH  - Female
MH  - Fibrinolytic Agents/*adverse effects/therapeutic use
MH  - Follow-Up Studies
MH  - Gastrointestinal Hemorrhage/chemically induced/epidemiology/*prevention & control
MH  - Humans
MH  - Lebanon/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Omeprazole/therapeutic use
MH  - Prognosis
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Proton-Translocating ATPases/antagonists & inhibitors
MH  - Rabeprazole
MH  - Retrospective Studies
MH  - Risk Factors
EDAT- 2008/02/19 09:00
MHDA- 2008/07/02 09:00
CRDT- 2008/02/19 09:00
PHST- 2008/02/19 09:00 [pubmed]
PHST- 2008/07/02 09:00 [medline]
PHST- 2008/02/19 09:00 [entrez]
AID - 10.1097/MCG.0b013e31802e63ff [doi]
PST - ppublish
SO  - J Clin Gastroenterol. 2008 Apr;42(4):368-72. doi: 10.1097/MCG.0b013e31802e63ff.