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Risk factors for upper gastrointestinal bleeding in coronary artery disease patients receiving both aspirin and
Kuang-Wei Huang1, Jiing-Chyuan Luo, Hsin-Bang Leu
1Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
Insights
Dual therapy for coronary artery disease increases upper gastrointestinal bleeding (UGIB) risk. Acute coronary syndrome (ACS) and mechanical ventilation are key early risks, while older age and prior peptic ulcer disease are late risks.
Area of Science:
- Cardiology
- Gastroenterology
- Clinical Research
Background:
- Dual therapy with aspirin and clopidogrel is crucial for acute coronary syndrome (ACS) and post-percutaneous coronary intervention (PCI) patients.
- This therapy significantly elevates the risk of upper gastrointestinal bleeding (UGIB).
- ACS patients face heightened UGIB risk due to stress and dual antiplatelet agents.
Purpose of the Study:
- To identify risk factors for UGIB in patients with coronary artery disease (CAD) undergoing dual antiplatelet therapy.
- To differentiate early-stage (≤ 2 weeks) and late-stage (> 2 weeks) UGIB risk factors.
Main Methods:
- Retrospective analysis of 534 patients receiving dual therapy for ACS or post-PCI.
- Cox regression analysis to determine independent risk factors for UGIB at early and late stages.
- Assessment of UGIB occurrence during a mean follow-up of 125 days.
Main Results:
- 67 patients (12.5%) developed UGIB; 32 early-stage, 35 late-stage.
- Proton pump inhibitor (PPI) use showed a protective effect (HR: 0.10, 95% CI: 0.01-0.71).
- Early-stage risks: ACS (HR: 2.67), mechanical ventilation (HR: 5.85). Late-stage risks: Old age >75 (HR: 2.13), prior peptic ulcer disease (HR: 3.27), mechanical ventilation (HR: 5.85).
Conclusions:
- ACS and mechanical ventilation are significant early UGIB risk factors.
- Old age, prior peptic ulcer disease, and mechanical ventilation are significant late UGIB risk factors.
- Proton pump inhibitors demonstrate a protective role against UGIB in patients on dual antiplatelet therapy for CAD.
Background:
Dual therapy (aspirin and clopidogrel) increases the risk of upper gastrointestinal bleeding (UGIB). Acute coronary syndrome (ACS), a critical ill condition, may increase the risk of UGIB due to stress-related mucosal disease and the impact of receiving dual antiplatelet agents. We identified risk factors of UGIB in patients with coronary artery disease (CAD) receiving dual therapy.
Methods:
Patients who received dual therapy due to ACS or postpercutaneous coronary intervention (elective, primary, or urgent) were enrolled retrospectively. We assessed the occurrence of UGIB and identified the risk factors for UGIB at early stage (dual therapy ≤ 2 weeks) and late stage (> 2 weeks) by Cox regression analysis.
Results:
During a mean follow-up period of 125 days, 67 (12.5 %) out of 534 patients developed UGIB (32 patients at early stage, 35 patients at late stage). Cox regression analysis showed that use of proton pump inhibitor therapy has a protective role in these patients [hazard ratio (HR): 0.10, 95% confidence interval (CI): 0.01-0.71]. ACS (HR: 2.67, 95% CI: 1.33-5.34) has a high risk of developing UGIB at an early stage. Old age (>75 years of age) (HR: 2.13, 95% CI: 1.02-4.47) and prior history of peptic ulcer disease (HR: 3.27, 95% CI: 1.28-8.34) each have an associated high risk for developing UGIB at a late stage. The use of mechanical ventilation (HR: 5.85, 95% CI: 2.19-15.58) also increased UGIB risk at both the early and late stages.
Conclusion:
ACS and mechanical ventilation are important risk factors of UGIB at the early stage (≤ 2 weeks). Additionally, old age (>75 years), past peptic ulcer disease history, and the use of mechanical ventilation play important roles in the occurrence of UGIB at late stage (>2 weeks). However, it was also noted that use of PPI plays a protective role in patients with CAD receiving aspirin and clopidogrel therapy.
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