title: Esomeprazole compared with famotidine in the prevention of upper gastrointestinal bleeding in patients with acute coronary syndrome or myocardial infarction.
abstract: OBJECTIVE
  Little is known about the efficacy of proton pump inhibitors compared with H(2) receptor antagonists in preventing adverse upper gastrointestinal complications in patients with acute coronary syndrome (ACS) or ST elevation myocardial infarction (STEMI) receiving aspirin, clopidogrel, and enoxaparin or thrombolytics. The objective of this study was to compare the efficacies of esomeprazole and famotidine in preventing gastrointestinal complications.
  
  
  METHODS
  A double-blind, randomized, controlled trial was performed in patients receiving a combination of aspirin, clopidogrel, and either enoxaparin or thrombolytics. Patients received either esomeprazole (20 mg nocte) or famotidine (40 mg nocte) orally for 4-52 weeks, depending on the duration of dual antiplatelet therapy. The primary end point was upper gastrointestinal bleeding (GIB), perforation, or obstruction from ulcer/erosion (http://www.clinicaltrials.gov NCT00683111).
  
  
  RESULTS
  In all, 311 patients were recruited, with 163 and 148 patients in the esomeprazole and famotidine groups, respectively. Mean (s.d.) follow-up was 19.2 (17.6) and 17.6 (18.0) weeks, respectively. One (0.6%) patient in the esomeprazole group and 9 (6.1%) in the famotidine group reached the primary end point (log-rank test, P=0.0052, hazard ratio=0.095, 95% confidence interval: 0.005-0.504); all had upper GIB.
  
  
  CONCLUSIONS
  In patients with ACS or STEMI, esomeprazole is superior to famotidine in preventing upper gastrointestinal complications related to aspirin, clopidogrel, and enoxaparin or thrombolytics.
authors: Department of Medicine and Geriatric, Ruttonjee Hospital, Hong Kong, China. ngfhong@hkucc.hku.hk
authors: Fook-Hong
authors: FH
authors: Ng
authors: P
authors: P
authors: Tunggal
authors: Wai-Ming
authors: WM
authors: Chu
authors: Kwok-Fai
authors: KF
authors: Lam
authors: Andrew
authors: A
authors: Li
authors: Kit
authors: K
authors: Chan
authors: Yuk-Kong
authors: YK
authors: Lau
authors: Carolyn
authors: C
authors: Kng
authors: K K
authors: KK
authors: Keung
authors: Ambrose
authors: A
authors: Kwan
authors: Benjamin C Y
authors: BC
authors: Wong
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy*; D000368:Aged; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D016009:Chi-Square Distribution; D000077144:Clopidogrel; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects; D064098:Esomeprazole / Q000008:administration & dosage / Q000627:therapeutic use*; D015738:Famotidine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D016016:Proportional Hazards Models; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D016896:Treatment Outcome
chemical_list: D000897:Anti-Ulcer Agents; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D015738:Famotidine; D000077144:Clopidogrel; D064098:Esomeprazole; D013988:Ticlopidine; D001241:Aspirin