PMID- 22345061
OWN - NLM
STAT- MEDLINE
DCOM- 20120802
LR  - 20211021
IS  - 1569-9285 (Electronic)
IS  - 1569-9293 (Print)
IS  - 1569-9285 (Linking)
VI  - 14
IP  - 5
DP  - 2012 May
TI  - Is routine stress ulcer prophylaxis of benefit for patients undergoing cardiac 
      surgery?
PG  - 622-8
LID - 10.1093/icvts/ivs019 [doi]
AB  - A best evidence topic in cardiac surgery was written according to a structured 
      protocol. We address whether routine pharmacological stress ulcer prophylaxis is 
      of benefit for patients undergoing cardiac surgery. One hundred and fifty-six 
      papers were found using the reported search, of which 10 represented the best 
      evidence to answer the clinical question. The authors, journal, date, country of 
      publication, patient group, study type, relevant outcomes and results of these 
      papers were tabulated. The results show that the incidence of stress ulcers 
      following cardiac surgery is low (0.45%), but remains associated with significant 
      morbidity and mortality. Five of the 7 studies demonstrated suppression of acid 
      secretion or decreased incidence of gastric complications in patients given 
      pharmacological stress ulcer prophylaxis, with the remaining two suggesting no 
      clinical benefit. One prospective study of 210 patients, randomized equally 
      between a proton pump inhibitor (PPI), histamine antagonist and teprenone, found 
      that PPIs were the most effective at reducing gastric complications after cardiac 
      surgery, including ulcer formation and upper gastrointestinal bleeding (UGIB). 
      However, a separate retrospective study suggested no difference in the outcomes 
      between the use of a PPI and a histamine antagonist. Of the studies focused on 
      histamine antagonists, one randomized control trial (RCT) showed that cimetidine 
      can reduce surgical stress, augment the immune system and reduce the intubation 
      time after cardiac surgery, although no direct association with UGIB was made. A 
      second prospectively randomized study of histamine antagonists demonstrated 
      superior pH control with famotidine and ranitidine, when compared with 
      cimetidine. Furthermore, haematological and neurological side-effects were noted 
      only with the use of cimetidine. A recent meta-analysis and systematic review of 
      the literature associated gastric acid suppression with an increased risk of 
      pneumonia. Two prospective cohort studies that examined the use of PPI in 
      conjunction with clopidogrel in patients with coronary artery disease concluded 
      that there was no association with an increase in major adverse cardiovascular 
      events with the use of PPIs. We conclude that the current evidence is marginally 
      in favour of the use of prophylactic PPIs. However, this is associated with an 
      increased risk of hospital-acquired pneumonia.
FAU - Shin, Jin-Sup
AU  - Shin JS
AD  - Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, UK.
FAU - Abah, Udo
AU  - Abah U
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
DEP - 20120217
PL  - England
TA  - Interact Cardiovasc Thorac Surg
JT  - Interactive cardiovascular and thoracic surgery
JID - 101158399
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
CIN - Interact Cardiovasc Thorac Surg. 2012 May;14(5):627-8. PMID: 22511455
CIN - Interact Cardiovasc Thorac Surg. 2012 May;14(5):628. PMID: 22511456
MH  - Aged
MH  - Anti-Ulcer Agents/adverse effects/*therapeutic use
MH  - Benchmarking
MH  - Cardiac Surgical Procedures/*adverse effects
MH  - Cross Infection/etiology
MH  - Evidence-Based Medicine
MH  - Female
MH  - Histamine H2 Antagonists/therapeutic use
MH  - Humans
MH  - Pneumonia/etiology
MH  - Proton Pump Inhibitors/therapeutic use
MH  - Risk Assessment
MH  - Risk Factors
MH  - Stomach Ulcer/etiology/*prevention & control
MH  - *Stress, Physiological
MH  - Stress, Psychological/*etiology
MH  - Treatment Outcome
PMC - PMC3735850
EDAT- 2012/02/22 06:00
MHDA- 2012/08/03 06:00
PMCR- 2013/05/01
CRDT- 2012/02/21 06:00
PHST- 2012/02/21 06:00 [entrez]
PHST- 2012/02/22 06:00 [pubmed]
PHST- 2012/08/03 06:00 [medline]
PHST- 2013/05/01 00:00 [pmc-release]
AID - ivs019 [pii]
AID - 10.1093/icvts/ivs019 [doi]
PST - ppublish
SO  - Interact Cardiovasc Thorac Surg. 2012 May;14(5):622-8. doi: 10.1093/icvts/ivs019. 
      Epub 2012 Feb 17.