title: Is prophylactic intravenous administration of a proton pump inhibitor necessary for perioperative management of cardiac surgery?
abstract: BACKGROUND
  Mortality from gastrointestinal (GI) hemorrhage caused by antiplatelet or anticoagulant therapy (or both) is quite high after cardiac surgery. We previously reported that proton pump inhibitor (PPI) therapy is indispensable in preventing postoperative GI complications. PPIs are usually administered intravenously immediately after surgery and subsequently by oral formulations. We conducted a prospective study to evaluate whether intravenous PPI followed by oral administration is more efficient as prophylaxis than oral-only administration.
  
  
  RESULTS
  We enrolled 40 patients scheduled to undergo coronary artery bypass grafting with cardiopulmonary bypass and randomly assigned them to receive oral PPIs alone (group 1) or intravenous PPI followed by oral administration (group 2). Postoperative upper GI endoscopy evaluations showed no evidence of GI bleeding. Only gastritis, esophagitis, and hiatal hernia were observed at similar incidences in the groups. Mean hospital stays were also similar, but the cost of PPI treatment was significantly lower in group 1.
  
  
  CONCLUSIONS
  No additional benefits of intravenous PPIs over oral formulations were demonstrated. Oral PPIs alone were effective and economical as prophylaxis against GI complications. Intravenous PPIs might be unnecessary in selected patients after cardiac surgery.
authors.affiliation: Department of Cardiovascular Surgery, Kitakanto Jyunkanki Hospital, Gunma, Japan. kishufujita@ccj.or.jp
authors.forename: Kishu
authors.initials: K
authors.lastname: Fujita
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Hata
authors.forename: Akira
authors.initials: A
authors.lastname: Sezai
authors.forename: Hisakuni
authors.initials: H
authors.lastname: Sekino
authors.forename: Kazutomo
authors.initials: K
authors.lastname: Minami
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D007564:Japan; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011322:Primary Prevention / Q000379:methods*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D011859:Radiography; D012016:Reference Values; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors