Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/28895
Title: Efficacy and safety of proton pump inhibitors versus histamine-2 receptor blockers in the cardiac surgical population: insights from the PEPTIC trial.
Austin Authors: van Diepen, Sean;Coulson, Tim G ;Wang, Xiaoming;Opgenorth, Dawn;Zuege, Danny J;Harris, Jo;Agyemang, Malik;Niven, Daniel J;Bellomo, Rinaldo ;Wright, Stephen E;Young, Paul J;Bagshaw, Sean M
Affiliation: Data Analytics Research and Evaluation (DARE) Centre
Department of Critical Care Medicine, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada..
Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada..
Department of Critical Care Medicine, University of Calgary, Alberta Health Services, Calgary, AB, Canada..
Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada..
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada..
Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, VIC, Australia..
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia..
Department of Critical Care, University of Melbourne, Parkville, VIC, Australia..
Medical Research Institute of New Zealand, Wellington, New Zealand..
Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand..
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia..
Intensive Care Unit, Freeman Hospital, Newcastle upon Tyne, UK..
Health Services Statistical and Analytic Methods, Alberta Health Services, Calgary, AB, Canada..
Department of Critical Care Medicine, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada..
eCritical Alberta, Alberta Health Services, Calgary, AB, Canada..
Issue Date: 25-Feb-2022
Date: 2022
Publication information: European Journal of Cardio-thoracic Surgery :2022; 62(2)
Abstract: The comparative effectiveness and safety of proton pump inhibitors (PPIs) versus histamine-2 receptor blockers for stress ulcer prophylaxis in the cardiac surgical intensive care unit population is uncertain. Although the Proton Pump Inhibitors versus Histamine-2 Receptor Blockers for Ulcer Prophylaxis Therapy in the Intensive Care Unit (PEPTIC) trial reported a higher risk of mortality in the PPI arm with no difference in gastrointestinal bleeding, detailed information on surgical variables and clinically relevant surgical subgroups was not available. The analysis included all Canadian cardiac surgery patients enrolled in the PEPTIC trial. Data were electronically linked using unique patient identifiers to a clinical information system. Outcomes of interest included in-hospital mortality, gastrointestinal bleeding, Clostridium difficile infections, ventilator-associated conditions and length of stay. We studied 823 (50.6%) randomized to PPIs and 805 (49.4%) to histamine-2-receptor blockers. In the intention-to-treat analysis, there were no differences in hospital mortality [PPI: 4.3% vs histamine-2 receptor blockers: 4.8%, adjusted odds ratio (aOR) 0.97, 95% confidence interval (CI) 0.55-1.70], gastrointestinal bleeding (3.9% vs 4.8%, aOR 1.09, 95% CI 0.66-1.81), C. difficile infections (0.9% vs 0.1%, aOR 0.18, 95% CI 0.02-1.59), ventilator-associated conditions (1.6% vs 1.7%, aOR 0.92, 95% CI 0.85-1.00) or median length of stay (9.2 vs 9.8 days, adjusted risk ratio 1.06, 85% CI 0.99-1.13). No significant treatment differences were observed among subgroups of interest or per-protocol populations. In a secondary analysis of cardiac surgery patients enrolled in the PEPTIC trial in Canada, no differences in effectiveness or safety were observed between use of PPIs and histamine-2 receptor blockers for stress ulcer prophylaxis. anzctr.org.au identifier: ACTRN12616000481471.
URI: https://ahro.austin.org.au/austinjspui/handle/1/28895
DOI: 10.1093/ejcts/ezac124
ORCID: 0000-0002-6688-828X
0000-0003-3571-3871
0000-0002-9527-0577
0000-0002-1650-8939
0000-0003-3633-6596
0000-0001-6182-268X
Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
PubMed URL: 35213716
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/35213716/
Type: Journal Article
Subjects: Clostridium difficile infections
Cardiac surgical intensive care unit
Gastrointestinal bleeding
Stress ulcer prophylaxis
Ventilator-associated conditions
Appears in Collections:Journal articles

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