Key result
Short-term PPIs do not increase hypomagnesemia or arrhythmia risk versus H2RAs after off-pump CABG.
Why the study?
Long-term use of proton-pump inhibitors can cause hypomagnesemia and arrhythmia, but their short-term effects after off-pump CABG compared to H2 receptor antagonists were unclear.
Does short-term use of proton-pump inhibitors increase the incidence of hypomagnesemia and arrhythmia compared to H2-receptor antagonists in patients following off-pump CABG?
RCT (n=271)
randomly divided
No
Does short-term use of proton-pump inhibitors increase the incidence of hypomagnesemia and arrhythmia compared to H2-receptor antagonists in patients following off-pump CABG?
Absolute Event Rate: 63.5% vs 56.7%
p-value: p=0.245
Short-term use of proton-pump inhibitors does not significantly increase the risk of hypomagnesemia or arrhythmia compared to H2-receptor antagonists after off-pump CABG.
Short-term PPI use after off-pump CABG showed no excess hypomagnesemia or arrhythmia versus H2RA; leaves open longer-term effects in broader cardiac populations.
Background: Long-term use of proton-pump inhibitors (PPI) can result in hypomagnesemia and arrhythmia. This study aimed to compare the effect of PPI and histamine 2-receptor antagonists (H2 RA) on the incidence of hypomagnesemia and arrhythmia in patients following off-pump coronary artery bypass surgery (CABG). Method: In this randomized-controlled clinical trial 290 patients admitted to the ICU after off-pump CABG were randomly divided into two groups of H2 RA (n=145) and PPI (n=145). For patients in the H2 RA group, 50 mg intravenous ranitidine was prescribed every 8 hours after the nothing by mouth (NPO) period, followed by 40 mg famotidine tablets after starting the oral regimen (PO). The PPI group received 40 mg pantozol IV injections every 12 hours during the NPO period and 40 mg pantozol tablets once daily after becoming PO. The patients were investigated for the development of hypomagnesemia and associated arrhythmia. Results: In total 271 patients with a mean age of 59.3±10 years completed the study (female/male=32.8%). Hypomagnesemia occurred in 60.1% of the patients, 76 (56.7%) in the H2 RA group and 87 (63.5%) in the PPI group (P=0.245), whereas arrhythmia had a prevalence of 12 (9.6%) and 15 (11.1%) cases, respectively (P=0.690). The mean time of occurrence of hypomagnesemia and arrhythmia was 1.75±1.08 and 3.0±0.9 days after the operation in the H2 RA group (P=0.111) and 1.47±0.7 and 2.9±1.5 days in the PPI group (P=0.897), respectively. Conclusion: Our study revealed that the short-term use of PPIs does not result in higher rates of hypomagnesemia and associated arrhythmia in comparison to H2 RA consumption after off-pump CABG.
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Abbaspour et al. (2023) conducted an RCT in Off-pump coronary artery bypass surgery (CABG) (n=271). Proton-pump inhibitors (Pantoprazole) vs. Histamine 2-receptor antagonists (Ranitidine/Famotidine) was evaluated on Incidence of hypomagnesemia (p=0.245). Short-term administration of proton-pump inhibitors did not significantly increase the rates of hypomagnesemia (63.5% vs 56.7%, P=0.245) or arrhythmia (11.1% vs 9.6%, P=0.690) compared to H2-receptor antagonists after off-pump CABG.
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