Lower gastrointestinal bleeding in patients with coronary artery disease on antithrombotics and subsequent mortality
Parita Patel1, Neha Nigam2, Neil Sengupta2
1Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA.
Insights
Patients with coronary artery disease (CAD) on triple therapy experiencing lower gastrointestinal bleeding (LGIB) face higher mortality risks. This highlights the need for careful management of antithrombotic medications in this vulnerable population.
Area of Science:
- Cardiology
- Gastroenterology
- Pharmacology
Background:
- Lower gastrointestinal bleeding (LGIB) is a frequent complication in patients with coronary artery disease (CAD) due to antithrombotic medication use.
- Limited data exist on mortality risk factors for these patients.
Purpose of the Study:
- To compare 90-day and 6-month mortality in CAD patients with LGIB on dual antiplatelet therapy (DAPT) or triple therapy versus aspirin alone.
- To identify risk factors for mortality in CAD patients hospitalized with LGIB while on antithrombotics.
Main Methods:
- Retrospective cohort study of 716 patients with LGIB and CAD on aspirin (2007-2015).
- Patient classification based on aspirin monotherapy, DAPT, or triple therapy using a machine-learning algorithm.
- Univariate and multivariate Cox proportional hazards models to assess mortality risk factors.
Main Results:
- Triple therapy was associated with increased 90-day (HR 3.23) and 6-month mortality (HR 2.46) in multivariate analysis.
- Holding anticoagulation was linked to higher 90-day mortality (HR 2.30).
- Of 716 patients, 65.9% were on aspirin, 25% on DAPT, and 9.1% on triple therapy.
Conclusions:
- Triple therapy significantly increases the risk of 90-day mortality in CAD patients hospitalized with LGIB.
- The findings underscore the critical need to evaluate antithrombotic regimens in patients with CAD and LGIB.
Background:
Lower gastrointestinal bleeding (LGIB) is a common complication for patients with coronary artery disease (CAD) due to the use of antithrombotic medications. Limited data exist describing which patients are at increased risk for mortality.
Aim:
This study aims to (i) determine whether patients on dual antiplatelet therapy (DAPT) or triple therapy are at higher risk of 90-day and 6-month mortality compared with patients on aspirin alone and (ii) evaluate risk factors for mortality in patients with CAD on antithrombotics hospitalized with LGIB.
Methods:
We conducted a retrospective cohort study of patients hospitalized with LGIB and CAD while on aspirin at a single academic medical center from 2007 to 2015. Patients were identified using a validated, machine-learning algorithm and classified by use of aspirin, DAPT, or triple therapy. Univariate and multivariate Cox proportional hazards were used to determine mortality associated risk factors.
Results:
Seven hundred sixteen patients were identified with LGIB and CAD. Four hundred seventy-two (65.9%) patients were on aspirin monotherapy, 179 (25%) on aspirin and thienopyridine (DAPT), and 65 (9.1%) on aspirin, thienopyridine, and systemic anticoagulant (triple therapy). On univariate analysis, triple therapy use was associated with increased risk of 90-day (hazard ratio [HR] 3.12, 95% confidence interval [CI] 1.52-5.92, P = 0.003) and 6-month (HR 2.46, 95%CI 1.29-4.35, P = 0.008) mortality. Holding anticoagulation was associated with higher mortality at 90 days (HR 2.30, 95%CI 1.27-4.07, P = 0.007). On multivariate analysis, after adjusting for confounding variables, the use of triple therapy remained associated with higher 90-day mortality (HR 3.23, 95%CI 1.56-6.16, P = 0.003).
Conclusion:
Triple therapy is associated with mortality at 90 days and at 6 months post discharge.
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