AJG:比较埃索美拉唑和法莫替丁预防消化道并发症的效果

2011-12-12

近日,国际著名杂志The American Journal of Gastroenterology在线发表了香港律敦治医院研究人员的最近研究成果“Esomeprazole Compared With Famotidine in the Prevention of Upper Gastrointestinal Bleeding in Patients With Acute Coronary Synd

近日,国际著名杂志The American Journal of Gastroenterology在线发表了香港律敦治医院研究人员的最近研究成果“Esomeprazole Compared With Famotidine in the Prevention of Upper Gastrointestinal Bleeding in Patients With Acute Coronary Syndrome or Myocardial Infarction。”本研究旨在比较埃索美拉唑和法莫替丁在预防消化道并发症方面的效果。

目前,对于质子泵抑制剂与H2受体拮抗剂在预防接受阿司匹林、氯吡格雷和依诺肝素或溶栓药治疗的急性冠脉综合征(ACS)或ST段抬高性心肌梗死(STEMI)患者发生上消化道不良并发症方面的效果,我们知之甚少。作者的研究结果发现在ACS或STEMI患者中,埃索美拉唑在预防阿司匹林、氯吡格雷和依诺肝素或溶栓药相关性上消化道并发症方面优于法莫替丁。

中国香港研究人员在接受阿司匹林、氯吡格雷和依诺肝素或溶栓药治疗的患者中进行了一项双盲、随机对照试验。患者接受口服埃索美拉唑(20 mg,夜间服用)或法莫替丁(40 mg,夜间服用)治疗4~52周,治疗时间长短取决于双联抗血小板治疗的持续时间。主要终点是上消化道出血(GIB)、穿孔或来自溃疡/糜烂的梗阻。

一共招募了311例患者,埃索美拉唑组和法莫替丁组分别为163例和148例。平均(标准差)随访时间分别为19.2(17.6)和 17.6(18.0)周。埃索美拉唑组患者和法莫替丁组中达到主要终点的患者分别为1例(0.6%)和9例(6.1%)(对数秩检验,P=0.0052,风险比=0.095,95%可信区间:0.005~0.504);所有患者均发生上GIB。(生物谷Bioon.com)

Esomeprazole Compared With Famotidine in the Prevention of Upper Gastrointestinal Bleeding in Patients With Acute Coronary Syndrome or Myocardial Infarction

Fook-Hong Ng MD1, P Tunggal MB, BS1, Wai-Ming Chu MB, BS1, Kwok-Fai Lam PhD2, Andrew Li MB, BS1, Kit Chan MB, BS1, Yuk-Kong Lau MB, BS, FACC1, Carolyn Kng MB, BCh1, K K Keung MB, BS1, Ambrose Kwan BSc3 and Benjamin C Y Wong MD, PhD4

OBJECTIVES: Little is known about the efficacy of proton pump inhibitors compared with H2 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.

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