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Pantoprazole IV & Oral Route in Gastrointestinal bleeding complications in high Bleeding Risk Acute Coronary Syndrome Patient

Pepcare (Pantoprazole)

Pantoprazole: Intravenous and oral or oral alone for averting gastrointestinal bleeding complications in high bleeding risk acute coronary syndrome patients?

The most beneficial route of administration (intravenous or oral) of proton pump inhibitors for superlative therapeutic outcomes (for preventing gastrointestinal bleeding) in patients with acute coronary syndrome (ACS) at high risk of developing bleeding complications is still argumentative. A study was conducted to compare effectiveness of intravenous plus oral pantoprazole with oral pantoprazole for preventing gastrointestinal bleeding in ACS patients at high bleeding risk. The study recruited 504 patients with ACS at high risk of developing bleeding complications. The patients were randomized into two groups. Group one (study group) enrolled 252 individuals administered with intravenous pantoprazole for five days followed by oral pantoprazole for 12 months. Group two (control group) enrolled 252 individuals administered with oral pantoprazole for 12 months. The outcomes assessed included major adverse cardiovascular events such as re-infarction, re-vascularization, stroke and death.

"Prevention of gastrointestinal bleeding in high bleeding risk patients with ACS, intravenous plus oral pantoprazole appeared to be more efficacious in comparison to oral therapy alone"

The relevant findings of the study:

  • There were no statistically significant changes in major adverse cardiovascular events between study and control group at the follow-up
  • The incidence of major gastrointestinal bleeding was reduced in the study group (1.2%) as against the control group (3.9%)
  • The bleeding rates within first 30 days were also reduced in the study group (0.3%) in comparison to the control group (2.7%).

The investigators thus concluded that incidence of major cardiac events was not different among the study and the control group. Alongside, for prevention of gastrointestinal bleeding in high bleeding risk patients with ACS, intravenous plus oral pantoprazole appeared to be more efficacious in comparison to oral therapy alone.

Source: Yao DK, Chen H, Wang L, Li HW, Wang LX. Comparison of Intravenous plus Oral Pantoprazole Therapy and Oral Pantoprazole Alone for Preventing Gastrointestinal Bleeding in Acute Coronary Syndrome Patients with High Bleeding Risk. Heart Lung Circ. 2015 Mar 14.