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document
Is prophylactic intravenous administration of a proton pump inhibitor necessary for perioperative management of cardiac surgery ? 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 . METHODS AND 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 . CONCLUSION 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 .
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Intervention_Pharmacological
proton pump inhibitor
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Intervention_Pharmacological
antiplatelet
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Intervention_Pharmacological
anticoagulant therapy
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Intervention_Pharmacological
proton pump inhibitor ( PPI ) therapy
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Intervention_Pharmacological
PPIs
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Intervention_Pharmacological
PPI
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Intervention_Pharmacological
receive oral PPIs alone ( group 1 ) or intravenous PPI followed by oral administration ( group 2 )
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Intervention_Pharmacological
PPIs
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Intervention_Pharmacological
PPIs
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Outcome_Physical
GI bleeding .
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Outcome_Adverse-effects
gastritis , esophagitis , and hiatal hernia
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Outcome_Other
Mean hospital stays
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Outcome_Other
cost of PPI treatment
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Participant_Condition
selected patients after cardiac surgery .