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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Endoscopy findings in patients on dual antiplatelet therapy following percutaneous coronary intervention
Victor Galusko1, Majd Protty2,3, Hasan N Haboubi4
1Department of Cardiology, Royal Gwent Hospital, Newport, UK vgalusko91@gmail.com.
Insights
Gastrointestinal bleeding (GIB) is infrequent after percutaneous coronary intervention (PCI) with dual antiplatelet therapy (DAPT). Risk scores help assess the need for urgent endoscopy in patients experiencing GIB.
Area of Science:
- Cardiology
- Gastroenterology
- Clinical Medicine
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for coronary artery disease.
- Dual antiplatelet therapy (DAPT) is frequently prescribed post-PCI to prevent thrombotic events.
- Gastrointestinal bleeding (GIB) is a potential complication associated with antiplatelet therapy.
Purpose of the Study:
- To investigate the association between DAPT following PCI and the incidence of GIB.
- To identify predictors of GIB and associated outcomes in patients undergoing PCI.
Main Methods:
- A retrospective analysis of 3342 patients who underwent PCI between August 2011 and December 2018.
- Analysis of oesophagogastroduodenoscopies (OGDs) performed within 12 months post-PCI.
- Evaluation of patient demographics, clinical factors, and bleeding risk scores.
Main Results:
- GIB occurred in 2% of all patients within 12 months post-PCI.
- Among patients undergoing OGD (n=128), GIB was observed in 36% within 30 days of DAPT initiation.
- Increased age, low hemoglobin (Hb ≤109 g/L), and high Glasgow-Blatchford score (≥8) predicted increased 12-month mortality.
- A significant drop in Hb (≥30 g/L) was a sensitive and specific marker for GIB on OGD.
Conclusions:
- GIB is an infrequent complication in patients on DAPT after PCI.
- Risk assessment scores, such as Glasgow-Blatchford and Rockall scores, are valuable for determining the urgency of OGD and the need for endoscopic intervention.
Purpose Of Study:
This study examines the associations between dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) and gastrointestinal bleeding (GIB), to explore possible predictors of outcomes.
Study Design:
Retrospective analysis of 3342 patients who underwent PCI between 1 August 2011 and 31 December 2018 in a single centre was carried out. Oesophagogastroduodenoscopies (OGDs) for patients 12 months post-PCI were analysed.
Results:
Blood loss occurred in 2% of all (3342) patients post-PCI within 12 months. 128 patients (63% male, mean age (SD) of 69.8 (10) years) who had PCI subsequently underwent an OGD within 12 months of the index PCI procedure. GIB occurred within the first 30 days of DAPT in 36% (n=13/36) of cases. There were no thrombotic events associated with cessation of one antiplatelet agent. Increased age, haemoglobin (Hb) ≤109 g/L and Glasgow-Blatchford score ≥8 were associated with increased 12-month mortality. An Hb drop of ≥30 g/L was a sensitive and specific marker for significant pathology and evidence of bleeding on OGD (sensitivity=0.83, specificity=0.81).
Conclusions:
GIB bleeding occurred infrequently in the patients post-PCI on DAPT. Risk assessment scores (such as Glasgow-Blatchford and Rockall scores) are useful tools to assess the urgency of OGD and need for endoscopic therapy.
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