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Risk Factors for Upper Gastrointestinal Bleeding in Patients Undergoing Percutaneous Coronary Intervention on Dual
Chun-Ting Shih1, Ting-Hsin Huang1, Chih-Ming Liang2
1Division of Cardiology.
Insights
Prophylactic anti-ulcer medications like PPIs or H2RAs did not significantly reduce upper gastrointestinal bleeding (UGIB) in coronary care unit patients after percutaneous coronary intervention (PCI) with dual antiplatelet treatment (DAPT). High-risk patients still require vigilant monitoring.
Area of Science:
- Cardiology
- Gastroenterology
- Clinical Pharmacology
Background:
- Patients in coronary care units (CCU) undergoing percutaneous coronary intervention (PCI) with dual antiplatelet treatment (DAPT) face a heightened risk of upper gastrointestinal bleeding (UGIB).
- The efficacy of histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) in preventing UGIB in this high-risk population remains unclear.
Purpose of the Study:
- To evaluate the effectiveness of prophylactic anti-ulcer medications (H2RAs and PPIs) in preventing UGIB among CCU patients treated with DAPT post-PCI.
- To identify risk factors associated with UGIB within 72 hours and beyond 72 hours after PCI in this patient cohort.
Main Methods:
- A retrospective study involving 288 CCU patients who underwent PCI and received DAPT.
- Assessed UGIB incidence at two time points: within 72 hours and after 72 hours post-catheterization.
- Analyzed patient history, medication regimens (including PPIs, H2RAs, and absence of prophylaxis), and clinical factors.
Main Results:
- Acute UGIB (within 72 hours) occurred in 8.3% of patients; cerebrovascular accident history and higher Killip grade were identified as risk factors.
- Delayed UGIB (beyond 72 hours) occurred in 4.9% of patients; chronic kidney disease and higher Killip grade were significant risk factors.
- No significant difference in UGIB rates was observed between groups receiving PPIs, H2RAs, or no prophylactic medication (p = 0.264). TriMatch analysis confirmed similar rates (7.5%, 7.5%, 5.0%; p = 0.875).
Conclusions:
- Prophylactic anti-ulcer medications did not significantly reduce UGIB incidence in CCU patients post-PCI with DAPT.
- Vigilant monitoring and consideration of prophylactic medication are recommended for high-risk UGIB patients in the CCU setting.
Background:
Patients in the coronary care unit (CCU) who undergo percutaneous coronary intervention (PCI) and receive dual antiplatelet treatment (DAPT) are at an increased risk of upper gastrointestinal bleeding (UGIB). The effectiveness of histamine-2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs) in preventing UGIB in this context remains uncertain.
Methods:
This retrospective study enrolled 288 CCU patients undergoing DAPT after PCI, and the incidence of UGIB was assessed at specific timeframes: within 72 hours and beyond 72 hours post catheterization. Factors considered included patient histories, medication regimens (PPIs, H2RAs), and the absence of prophylactic UGIB medication.
Results:
Within 72 hours, acute UGIB occurred in 8.3% of the patients, with a history of cerebrovascular accident and higher Killip grade identified as risk factors. Excluding the acute cases, the other patients received PPIs (n = 41), H2RAs (n = 57), or no prophylactic medication (n = 166). Delayed UGIB (> 72 hours) occurred in 4.9% of the patients, with chronic kidney disease and higher Killip grade identified as significant risk factors. UGIB rates in the PPI, H2RA, and non-prophylactic groups showed no significant difference (p = 0.264), and TriMatch analysis revealed consistent rates (7.5%, 7.5%, 5.0%) (p = 0.875).
Conclusions:
No significant difference was found in the incidence of UGIB post PCI between the patients who did and did not receive prophylactic anti-ulcer medications. However, prophylactic medication and vigilant monitoring are suggested for high-risk UGIB patients within the critical CCU setting.
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