Understanding gastrointestinal bleeding in patients with cardiac disease: an interdisciplinary approach

Cardiovascular disease remains the leading cause of global mortality and a significant contributor to disability. The incidence of gastrointestinal bleeding (GIB) varies across cardiac conditions, with notable risks observed in patients undergoing complex antiplatelet or anticoagulant therapy, acute coronary syndrome, hypertrophic cardiomyopathy, percutaneous coronary interventions, mechanical cardiac support, acute decompensated heart failure, and post-cardiac surgery.

A comprehensive search of the PubMed/Medline database was conducted to retrieve articles related to GIB and cardiovascular disease from 2014 to 2024. The authors then synthesized a narrative review that endorses an interdisciplinary approach to this challenging paradigm, drawing from cardiology and gastroenterology perspectives to provide a comprehensive overview of the current understanding of the risk of GIB in cardiac patients.

In acute coronary syndrome, upper GIB significantly increases mortality risk, with early endoscopic intervention proving beneficial. Post-coronary revascularization presents a low GIB incidence but a high mortality rate when it occurs. Decompensated heart failure patients frequently experience GIB due to concomitant conditions. Cardiogenic shock and mechanical cardiac support also show notable GIB risks, with mechanical support patients facing higher mortality. Following transcatheter aortic valve implantation, GIB incidence is low, but hospitalization rates are significant.