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Given that clot stability is affected by gastric pH, investigators hypothesized that preemptive use of proton-pump inhibitors before endoscopy would be beneficial in the management of upper gastrointestinal bleeding. The researchers randomized 638 patients after stabilization to receive intravenous infusion of placebo or omeprazole given as an 80-mg bolus followed by continuous infusion of 8 mg/hour until endoscopy.
Patients who required ulcer hemostasis received continuous infusion for 3 days, followed by oral therapy. Patients who could not be stabilized, who needed urgent surgical intervention, or who were taking long-term aspirin therapy were excluded. Warfarin-induced coagulopathy was reversed, if necessary.
The primary endpoint of need …