P Mohammadi - Department of Internal Medicine, School of Medicine, shahid Beheshti University of Medical Sciences, Tehran, Iran
M Sedaghat - Department of Internal Medicine, School of Medicine, shahid Beheshti University of Medical Sciences, Tehran, Iran
Z Rashvandi - Department of Internal Medicine, School of Medicine, shahid Beheshti University of Medical Sciences, Tehran, Iran

Background and Objective: 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. Methods: This randomized clinical trial was performed in emergency department of Imam Hussein Hospital in Tehran, Iran between ۲۰۱۸ and ۲۰۱۹ among ۱۲۷۶ consecutive ACS patients with high risk of gastrointestinal bleeding.The participants were randomly received either pantoprazole ۴۰ mg or famotidine ۴۰ mg daily. The melena, hematemesis, hematochezia, and hemoglobin level were compared across the groups after one month. Findings: The results in this study demonstrated that melena was seen in ۱.۱% and ۳.۸% in pantoprazole and famotidine groups, respectively with significant difference (P=۰.۰۰۲). Hematemesis was seen in ۰.۶% and ۱.۹% in pantoprazole and famotidine groups, respectively with significant difference (P=۰.۰۴۴). Also, hematochezia was seen in ۰.۳% and ۰.۸% in pantoprazole and famotidine groups, respectively without significant difference (P=۰.۴۵۲). The mean hemoglobin was ۱۱.۹۸ and ۱۱.۸۲ in pantoprazole and famotidine groups, respectively with significant difference (P=۰.۰۲۱). Conclusion: 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.

Pantoprazole, Gastrointestinal bleeding, Acute coronary syndrome