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Prediction and prevention of upper gastrointestinal bleeding after cardiac surgery: a case control study

Mamatha Bhat1, Martin Larocque, Marcos Amorim

  • 1McGill University, Montreal, Quebec.

Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie
|June 22, 2012
PubMed

Insights

Upper GI bleeding after cardiac surgery is predicted by longer mechanical ventilation and elevated INR. Clostridium difficile colitis also increases risk. Acid suppression may offer protection.

Area of Science:

  • Cardiovascular Surgery
  • Gastroenterology
  • Critical Care Medicine

Background:

  • Gastrointestinal complications, especially bleeding, are common after cardiovascular surgery.
  • Identifying predictors of upper gastrointestinal bleeding (UGIB) is crucial for improving patient outcomes.

Purpose of the Study:

  • To determine independent predictors of upper GI bleeding (UGIB) following cardiovascular surgery.
  • To enhance prognostication and guide preventative strategies for UGIB in cardiac surgery patients.

Main Methods:

  • A case-control study analyzed institutional records from 2002-2005.
  • Patients who developed in-hospital UGIB post-cardiac surgery were matched with controls.
  • Conditional logistic regression identified significant predictors after adjusting for confounders.

Main Results:

  • Independent risk factors for UGIB included prolonged mechanical ventilation (OR 3.01), elevated international normalized ratio (INR) (OR 1.91), and Clostridium difficile colitis (OR 3.15).
  • Histamine type 2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) showed a trend towards protection, but were not definitively effective due to small sample sizes.

Conclusions:

  • UGIB events typically occur around 10 days post-cardiac surgery, often in patients with complex postoperative courses.
  • Increased duration of mechanical ventilation and elevated INR are significant predictors of UGIB.
  • Consideration of acid suppression (PPIs or H2RAs) and vigilance for C. difficile colitis are recommended for at-risk patients.
Abstract

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