Outcome of acute upper gastrointestinal bleeding in patients with coronary artery disease: A matched case-control
Kessarin Thanapirom1, Wiriyaporn Ridtitid1, Rungsun Rerknimitr1
1Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Insights
Coronary artery disease (CAD) patients with upper gastrointestinal bleeding (UGIB) experienced similar outcomes to non-CAD patients, except for longer hospital stays. This study highlights that CAD does not negatively impact UGIB treatment outcomes.
Area of Science:
- Gastroenterology
- Cardiology
- Internal Medicine
Background:
- Patients with coronary artery disease (CAD) have an increased risk of upper gastrointestinal bleeding (UGIB) due to antiplatelet therapy.
- Limited data exists on the treatment outcomes of UGIB in CAD patients.
Purpose of the Study:
- To compare the clinical characteristics and outcomes of UGIB in patients with CAD versus those without CAD.
Main Methods:
- A prospective, multi-center cohort study (THAI UGIB-2010) enrolled 981 patients with acute UGIB.
- A matched case-control analysis was performed using data from 11 tertiary referral hospitals in Thailand (January 2010 - September 2011).
Main Results:
- 61 CAD patients were matched with 244 non-CAD patients.
- CAD patients were older, more frequently used antiplatelets and warfarin, and had higher bleeding risk scores (Glasgow-Blatchford, Rockall).
- Peptic ulcers were more common in CAD patients. Mortality, re-bleeding, and need for intervention were similar, but CAD patients had longer hospital stays.
Conclusions:
- Concomitant CAD in UGIB patients did not significantly affect treatment outcomes in Thailand, apart from a longer hospital stay.
- The findings suggest that CAD is not an independent predictor of poor UGIB outcomes in this population.
Background/Aim:
The risk of upper gastrointestinal bleeding (UGIB) increases in patients with coronary artery disease (CAD) due to the frequent use of antiplatelets. There is some data reporting on treatment outcomes in CAD patients presenting with UGIB. We aim to determine the clinical characteristics and outcomes of UGIB in patients with CAD, compared with non-CAD patients.
Patients And Methods:
We conducted a prospective multi-center cohort study (THAI UGIB-2010) that enrolled 981 consecutive hospitalized patients with acute UGIB. A matched case-control analysis using this database, which was collected from 11 tertiary referral hospitals in Thailand between January 2010 and September 2011, was performed.
Result:
Of 981 hospitalized patients with UGIB, there were 61 CAD patients and 244 gender-matched non-CAD patients (ratio 1:4). UGIB patients with CAD were significantly older, and had more frequently used antiplatelets and warfarin than in non-CAD patients. Compared with non-CAD, the CAD patients had significantly higher Glasgow-Blatchford score, full and pre-endoscopic Rockall score and full. Peptic ulcer in CAD patients was identified more often than in non-CAD patients. UGIB patients with CAD and non-CAD had similar outcomes with regard to mortality rate, re-bleeding, surgery, embolization, and packed erythrocyte transfusion. However, CAD patients had longer duration of hospital stays than non-CAD patients. Two CAD patients died from cardiac arrest after endoscopy, whereas three non-CAD patients died from pneumonia and acute renal failure during their hospitalization.
Conclusion:
In Thailand, patients presenting with UGIB, concomitant CAD did not affect clinical outcome of treatment, compared with non-CAD patients, except for longer hospital stay.
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