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Efficacy and safety of proton pump inhibitors versus histamine-2 receptor blockers in the cardiac surgical population: insights from the PEPTIC trial.

Authors :
Diepen, Sean van
Coulson, Tim
Wang, Xiaoming
Opgenorth, Dawn
Zuege, Danny J
Harris, Jo
Agyemang, Malik
Niven, Daniel J
Bellomo, Rinaldo
Wright, Stephen E
Young, Paul J
Bagshaw, Sean M
Group, for the PEPTIC study investigators and the ANZICS Clinical Trials
Source :
European Journal of Cardio-Thoracic Surgery. Aug2022, Vol. 62 Issue 2, p1-8. 8p.
Publication Year :
2022

Abstract

Open in new tab Download slide OBJECTIVES The comparative effectiveness and safety of proton pump inhibitors (PPIs) versus histamine-2 receptor blockers for stress ulcer prophylaxis in the cardiac surgical intensive care unit population is uncertain. Although the Proton Pump Inhibitors versus Histamine-2 Receptor Blockers for Ulcer Prophylaxis Therapy in the Intensive Care Unit (PEPTIC) trial reported a higher risk of mortality in the PPI arm with no difference in gastrointestinal bleeding, detailed information on surgical variables and clinically relevant surgical subgroups was not available. METHODS The analysis included all Canadian cardiac surgery patients enrolled in the PEPTIC trial. Data were electronically linked using unique patient identifiers to a clinical information system. Outcomes of interest included in-hospital mortality, gastrointestinal bleeding, Clostridium difficile infections, ventilator-associated conditions and length of stay. RESULTS We studied 823 (50.6%) randomized to PPIs and 805 (49.4%) to histamine-2-receptor blockers. In the intention-to-treat analysis, there were no differences in hospital mortality [PPI: 4.3% vs histamine-2 receptor blockers: 4.8%, adjusted odds ratio (aOR) 0.97, 95% confidence interval (CI) 0.55–1.70], gastrointestinal bleeding (3.9% vs 4.8%, aOR 1.09, 95% CI 0.66–1.81), C. difficile infections (0.9% vs 0.1%, aOR 0.18, 95% CI 0.02–1.59), ventilator-associated conditions (1.6% vs 1.7%, aOR 0.92, 95% CI 0.85–1.00) or median length of stay (9.2 vs 9.8 days, adjusted risk ratio 1.06, 85% CI 0.99–1.13). No significant treatment differences were observed among subgroups of interest or per-protocol populations. CONCLUSIONS In a secondary analysis of cardiac surgery patients enrolled in the PEPTIC trial in Canada, no differences in effectiveness or safety were observed between use of PPIs and histamine-2 receptor blockers for stress ulcer prophylaxis. Clinical trial registration number anzctr.org.au identifier: ACTRN12616000481471. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
10107940
Volume :
62
Issue :
2
Database :
Academic Search Index
Journal :
European Journal of Cardio-Thoracic Surgery
Publication Type :
Academic Journal
Accession number :
158340389
Full Text :
https://doi.org/10.1093/ejcts/ezac124