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Proton-pump inhibitors can decrease gastrointestinal bleeding after percutaneous coronary intervention
Zongdan Jiang1, Hailu Wu, Zhaotao Duan
1Department of Gastroenterology, Nanjing First Hospital Affiliated to Nanjing Medical University, 68, Changle Road, Nanjing 210006, China.
Insights
Gastrointestinal bleeding occurred in 1.3% of patients after percutaneous coronary intervention (PCI). Proton-pump inhibitor (PPI) use was found to be safe and effective in preventing bleeding events in patients receiving aspirin and clopidogrel.
Area of Science:
- Cardiology
- Gastroenterology
- Clinical Research
Background:
- Current acute coronary syndrome (ACS) therapies target coagulation and platelet inhibition, reducing morbidity and mortality.
- However, these treatments increase the risk of bleeding, necessitating further investigation into associated complications.
Purpose of the Study:
- To determine the incidence of gastrointestinal bleeding (GIB) following percutaneous coronary intervention (PCI).
- To evaluate the efficacy of proton-pump inhibitor (PPI) treatment in mitigating GIB risk in patients undergoing PCI.
Main Methods:
- A case-control study was conducted at Nanjing First Hospital from 2008-2011.
- Gastrointestinal bleeding events within one year post-PCI were identified and analyzed using linked departmental databases.
- Statistical analyses included independent two-sample Student's t-test, Fisher's exact P value, and logistic regression to identify risk and protective factors.
Main Results:
- The incidence of GIB after PCI was 1.3% (35/2680 patients).
- Identified risk factors for GIB included advanced age, female gender, smoking, alcohol consumption, history of peptic ulcer, and prior GIB.
- Proton-pump inhibitor (PPI) use post-PCI was significantly associated with a reduced risk of GIB (P=0.000).
Conclusions:
- The incidence of GIB with dual antiplatelet therapy (aspirin and clopidogrel) post-PCI is 1.3%.
- Advanced age, female sex, smoking, drinking, and a history of peptic ulcer or GIB are significant risk factors.
- PPIs are safe and effective for preventing and treating GIB in patients on dual antiplatelet therapy after PCI.
Background:
Current medical therapies for patients who have an acute coronary syndrome (ACS) focus on the coagulation cascade and platelet inhibition. These, coupled with early use of cardiac catheterization and revascularization, have decreased morbidity and mortality rates in patients who have acute ischemic heart disease with risk of bleeding.
Objective:
The study aimed to determine the incidence of gastrointestinal bleeding after percutaneous coronary intervention (PCI). The effect of proton-pump inhibitor (PPI) treatment was also analyzed.
Methods:
This case-control study evaluated gastrointestinal bleeding within a year of PCI for stable angina and acute coronary syndromes at Nanjing First Hospital between 2008 and 2011. Cases were identified and outcomes assessed using linkage analysis of data from cardiology and gastroenterology department databases. Analysis of the case and control groups for both risk and protective factors was performed using independent two-sample Student's t-test with Fisher's exact P value and logistic regression.
Results:
The incidence of gastrointestinal bleeding following PCI was 1.3% (35/2680 patients). The risk factors for gastrointestinal bleeding were advanced age, female gender, smoking, drinking, previous peptic ulcer and previous gastrointestinal bleeding. PPI use after PCI (P=0.000) was accompanied by a lower risk of gastrointestinal bleeding, with only a few cases of gastrointestinal bleeding events reported.
Conclusion:
The incidence of gastrointestinal bleeding associated with the combination of aspirin and clopidogrel therapy was estimated to be 1.3%. Advanced age, being female, smokers, drinkers, previous peptic ulcer and previous gastrointestinal bleeding were significant independent risk factors. PPI for the prevention and treatment of gastrointestinal bleeding induced by the combination of aspirin and clopidogrel in patients after PCI was safe and effective.
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