Pantoprazole works equally well for stress ulcer prophylaxis in COVID-19

This substudy provides the first randomized-trial evidence that pantoprazole reduces clinically important upper gastrointestinal bleeding in ventilated patients regardless of SARS-CoV-2 status, countering earlier observational concerns about acid suppression harm in COVID-19.

pantoprazoleproton pump inhibitorstress ulcer prophylaxisCOVID-19SARS-CoV-2mechanical ventilationICUupper GI bleedingREVISEcritical caresubstudy Clinical Pharmacy Practice

Background Information

Pantoprazole safe in ventilated SARS-CoV-2 patients, reducing gastrointestinal bleeding.

Pantoprazole use in invasively ventilated patients with SARS-CoV-2 may influence clinical outcomes, crucial for ICU management. Among the SARS-CoV-2 cohort, 11.7% developed pulmonary embolism and 9.2% developed deep-vein thrombosis. Pantoprazole reduced upper gastrointestinal bleeding without impacting mortality or other outcomes. Pantoprazole did not increase bleeding risk in patients with SARS-CoV-2, supporting its use in ICU settings for stress ulcer prophylaxis without adversely affecting mortality. Pantoprazole is safe for reducing upper gastrointestinal bleeding in critically ill SARS-CoV-2 patients.

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Authors: Dennis B, Heels-Ansdell D, Ibrahim Q, Basmaji J, Thabane L, Guyatt G, Saunders L, Hand L, Loy O, Zytaruk N, Hardie M, Deane AM, Marshall JC, Arabi Y, Lauzier F, Dionne JC, Burns KE, Alhazzani W, Vazquez-Grande G, Geagea A, Myburgh J, Muscedere J, English S, Binnie A, Tsang JL, Hunt M, Ostermann M, Al-Fares AA, Knowles S, Ahmed A, Cook DJ, REVISE Investigators and the Canadian Critical Care Trials Group

Citation: Dennis B, Heels-Ansdell D, Ibrahim Q, et al. Proton pump inhibitors in invasively ventilated patients with SARS-CoV-2: a substudy of the re-evaluating the inhibition of stress erosions trial. BMJ open. 2026;16(8):e119937. doi:10.1136/bmjopen-2026-119937

Article Links: PubMed · Journal / DOI

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Executive Summary

Study Design

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Secondary Outcomes & Safety Profile

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