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Upper gastrointestinal bleeding in patients receiving dual antiplatelet therapy after coronary stenting

Hiroshi Yasuda1, Masaya Yamada, Susumu Sawada

  • 1Division of Gastroenterology, Showa University Fujigaoka Hospital. hyasuda@marianna-u.ac.jp

Internal Medicine (Tokyo, Japan)
|October 3, 2009
PubMed

Insights

Anti-secretory drugs reduce upper gastrointestinal bleeding risk in patients on dual antiplatelet therapy after drug-eluting stent implantation. However, proton pump inhibitors may reduce antiplatelet therapy effectiveness.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Pharmacology

Background:

  • Dual antiplatelet therapy (DAPT) is crucial after drug-eluting stent (DES) implantation for coronary heart disease.
  • Upper gastrointestinal (UGI) bleeding is a significant risk associated with DAPT.
  • Proton pump inhibitors (PPIs) are commonly used to prevent UGI bleeding but may interact with antiplatelet agents.

Purpose of the Study:

  • To evaluate the risk of UGI bleeding in patients undergoing DES implantation and receiving DAPT.
  • To assess the protective effect of anti-secretory drugs, including PPIs and H2 receptor antagonists (H2RAs), against UGI bleeding.
  • To investigate the impact of anti-secretory drugs on cardiovascular outcomes in patients on DAPT.

Main Methods:

  • Retrospective analysis of 243 patients who received DES implantation and DAPT.
  • Assessment of UGI bleeding events as the primary outcome.
  • Coronary angiography (CAG) findings used to evaluate cardiovascular outcomes.
  • Data collected from medical records.

Main Results:

  • No UGI bleeding occurred in patients taking anti-secretory drugs.
  • The 1- and 2-year cumulative incidences of UGI bleeding were 4.5% and 9.2% in patients not taking anti-secretory drugs.
  • Significantly more coronary artery stenotic lesions were observed in patients taking PPIs compared to those not taking anti-secretory drugs or taking H2RAs.

Conclusions:

  • Concomitant use of anti-secretory agents significantly reduces the risk of UGI bleeding in patients on DAPT post-DES.
  • Proton pump inhibitor use may attenuate the effectiveness of DAPT, potentially impacting cardiovascular outcomes.
Abstract

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