Effect of pantoprazole on prevention of gastrointestinal bleeding in acute coronary syndrome patients with high risk of gastrointestinal bleeding

Determination of best preventive approach for gastrointestinal bleeding in Acute Coronary Syndrome (ACS) patients with high risk of gastrointestinal bleeding is crucial. This study aimed to determine the effect of pantoprazole on prevention of gastrointestinal bleeding in ACS patients with high risk of gastrointestinal bleeding.

This randomized clinical trial was performed in emergency department of Imam Hussein Hospital in Tehran, Iran between 2018 and 2019 among 1276 consecutive ACS patients with high risk of gastrointestinal bleeding.The participants were randomly received either pantoprazole 40 mg or famotidine 40 mg daily. The melena, hematemesis, hematochezia, and hemoglobin level were compared across the groups after one month.

The results in this study demonstrated that melena was seen in 1.1% and 3.8% in pantoprazole and famotidine groups, respectively with significant difference (P=0.002). Hematemesis was seen in 0.6% and 1.9% in pantoprazole and famotidine groups, respectively with significant difference (P=0.044). Also, hematochezia was seen in 0.3% and 0.8% in pantoprazole and famotidine groups, respectively without significant difference (P=0.452). The mean hemoglobin was 11.98 and 11.82 in pantoprazole and famotidine groups, respectively with significant difference (P=0.021).

This study showed that pantoprazole (versus famotidine) is effective for prevention of gastrointestinal bleeding in Acute Coronary Syndrome patients with high risk of gastrointestinal bleeding.