Pantoprazole Reduces GI Bleeding in Ventilated Patients

On MONDAY, June 17, 2024, a study published in the New England Journal of Medicine revealed that pantoprazole significantly reduces the risk of clinically important upper gastrointestinal bleeding in patients undergoing invasive ventilation, without increasing mortality. The study's findings were also discussed at the annual Critical Care Reviews Meeting held from June 12 to 14 in Belfast, Northern Ireland.

The research was led by Deborah Cook, M.D., from McMaster University in Hamilton, Ontario, Canada. The study involved critically ill adults who were receiving invasive ventilation. These patients were randomly assigned to receive either intravenous pantoprazole (40 mg daily) or a matching placebo. This international randomized trial included a total of 4,821 patients across 68 intensive care units.

The results showed that clinically important upper gastrointestinal bleeding occurred in 25 out of 2,385 patients treated with pantoprazole, compared to 84 out of 2,377 patients who received the placebo. This translates to a bleeding incidence of 1.0 percent in the pantoprazole group versus 3.5 percent in the placebo group, with a hazard ratio of 0.30 (95 percent confidence interval, 0.19 to 0.47; P < 0.001).

Additionally, the study found no significant difference in mortality rates between the two groups. Death from any cause at 90 days was reported in 29.1 percent of the pantoprazole group and 30.9 percent of the placebo group, yielding a hazard ratio of 0.94 (95 percent confidence interval, 0.85 to 1.04; P = 0.25). While pantoprazole effectively reduced significant upper gastrointestinal bleeding, other secondary outcomes showed no notable differences between the two groups.

The authors of the study concluded that the use of pantoprazole is associated with a lower risk of clinically important upper gastrointestinal bleeding compared to a placebo, without affecting overall mortality rates.