Please select the eligibility criteria that correspond to the clinical trial below.
Title: Famotidine Compared With Esomeprazole in the Prevention of Ulcer Complications in Patients With Acute Coronary Syndrome or Myocardial Infarction
Brief Summary: Aspirin and clopidogrel +/- heparin or thrombolytic co-therapy is well established and effective treatment for unstable cardiac patients. However, the major complication was gastrointestinal bleeding (GIB) due to peptic ulcer. In the prevention of GIB, anti-ulcer drug either H2-receptor antagonist (H2RA) and proton pump inhibitor (PPI) were commonly prescribed. There has been no prospective controlled study to compare the efficacy of these two classes of anti-ulcer drugs.


Options:
A: INCLUSION CRITERIA:

* Acute admission to the ICU
* Age ≥ 18 years
* One or more of the following risk factors:

  * Shock (continuous infusion with vasopressors or inotropes, systolic blood pressure \< 90 mmHg, mean arterial blood pressure \< 70 mmHg or lactate \> 4 mmol/l)
  * Acute or chronic intermittent or continuous renal replacement therapy
  * Invasive mechanical ventilation which is expected to last \> 24 hours
  * Coagulopathy (platelets \< 50 x 109/l or international normalized ratio (INR) \> 1.5 or prothrombin time (PT) \> 20 seconds) documented within the last 24 hours
  * Ongoing treatment with anticoagulant drugs (prophylaxis doses excluded)
  * History of coagulopathy (platelets \< 50 x 109/l or INR \> 1.5 or PT \> 20 seconds) within 6 months prior to hospital admission
  * History of chronic liver disease (portal hypertension, cirrhosis proven by biopsy, computed tomography (CT) scan or ultrasound, history of variceal bleeding or hepatic encephalopathy in the past medical history)

EXCLUSION CRITERIA:

* Contraindications to PPI
* Ongoing treatment with PPI and/or H2RA on a daily basis
* GI bleeding of any origin during current hospital admission
* Diagnosed with peptic ulcer during current hospital admission
* Organ transplant during current hospital admission
* Withdrawal from active therapy or brain death
* Fertile woman with positive urine human chorionic gonadotropin (hCG) or plasma-hCG
* Consent according to national regulations not obtainable
B: Inclusion Criteria:

* Critically ill male or female subjects 18 years or older who have a baseline gastric aspirate pH less then or equal to 4
* Subjects admitted to an ICU requiring mechanically ventilated
* Subjects will have at least one additional stress ulcer risk factor

Exclusion Criteria:

* Anticipated use of pre-pyloric enteral feeding after screening until the end of study
* Physician estimated survival of less then 96 hours
* Anticipation of major surgery within 96 hours of study enrollment
C: Inclusion Criteria:

* Planned CABG and/or valve surgery
* Left ventricular dysfunction (EF≤ 45%)
* Age \> 18 years
* able to give written information consent

Exclusion Criteria:

* Existing permanent pace maker
* Atrial fibrillation
* Enrolment in other research protocols
* Inability to give written informed consent
* Heart transplant
* Pre operative cardiovascular instability
D: Inclusion Criteria:

* patients admitted for acute coronary syndrome or acute myocardial infarction requiring active treatment with aspirin clopidogrel and (enoxaparin or thrombolytics.)

Exclusion Criteria:

* known active peptic ulcer disease or gastrointestinal within 8 wk
* known iron deficiency anemia with Hb \< 10 gm/dl
* mechanical ventilation
* active cancer, liver cirrhosis, end-stage renal failure
* life expectancy \< 1 yr
* known allergic to aspirin, clopidogrel, enoxaparin famotidine or esomeprazole
* pregnancy, lactation, child-bearing potential in the absence of contraception,
* co-prescription of NSAID, corticosteroid, or warfarin
* non-oral feeding or impaired GI absorption e.g. vomiting
* already on proton pump inhibitor for \> 1 day or another clinical trial drug for ulcer disease

Answer: D