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[Clinically manifest gastrointestinal bleeding in patients subject to coronary angiography]
Insights
Upper gastrointestinal bleeding after coronary angiography is uncommon but carries a high mortality risk. Duodenal peptic lesions, often linked to aspirin use, are the most common cause.
Area of Science:
- Cardiology
- Gastroenterology
- Clinical Medicine
Background:
- Coronary angiography is a common procedure for diagnosing heart conditions.
- Upper gastrointestinal bleeding is a potential complication of medical treatments and procedures.
Purpose of the Study:
- To determine the incidence and sources of acute upper gastrointestinal bleeding following coronary angiography.
- To identify risk factors associated with this complication.
Main Methods:
- A cohort of 5,955 patients undergoing coronary angiography were evaluated.
- Gastroscopy was used to identify sources of bleeding in affected patients and assess pathologies in a control group.
Main Results:
- Nine patients (0.15%) experienced upper gastrointestinal bleeding within days of angiography, with a 33% mortality rate.
- Duodenal peptic lesions were the most frequent source of bleeding (44%).
- Patients with bleeding were significantly older; regular acetylsalicylic acid use was associated with a higher incidence of ulcers.
Conclusions:
- Acute upper gastrointestinal bleeding is a rare but serious complication of coronary angiography.
- Duodenal peptic lesions, potentially exacerbated by acetylsalicylic acid, are the primary cause of bleeding.
- The high mortality rate underscores the need for vigilance and prompt management.
Unlabelled:
PATIENT SET AND METHODOLOGY: The authors evaluated the incidence of acute bleeding from the upper gastrointestinal tract in 5,955 patients (of which 3,684 men and 2,271 women) during hospitalisation for coronary angiography, and the incidence of potential sources of bleeding from the upper gastrointestinal tract in the patients without bleeding.
Results:
Bleeding occurred in 9 persons, within 3.4 +/- 3.6 days of the coronary angiography (the median of 1.0 day), with a 33% mortality rate. An ulcer of the duodenal bulbus or bulbitis were detected in four cases (44%), esophagitis in one case (11%), esophageal varices in one case, stomach carcinoma in one case, and the source of bleeding could not be detected in 2 cases. Patients with bleeding were significantly older than those without bleeding (73.6 +/- 4.4 years vs. 65.8 +/- 10.6 years, p < 0.001). Treatment with clopidogrel or abciximab was not associated with a higher incidence of bleeding (p > 0.05). In 42 patients without bleeding, the following pathologies were detected by gastroscopy: esophagitis (31%), mouth and stomach ulcers (36%), duodenal ulcers (21%), (12%), esophageal varices (2%) The incidence of mouth ulcers, stomach ulcers and duodenal ulcers was significantly higher in patients taking acetylsalicylic acid on a regular basis (p < 0.025).
Conclusion:
Bleeding from the upper gastrointestinal tract is not frequent shortly after coronary angiography, but the related mortality is high. The most frequent source of bleeding are duodenal peptic lesions most likely caused by previous treatment by acetylsalicylic acid.
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