Clinically manifest gastrointestinal bleeding in patients subject to coronary angiography

Czech version

Authors: V. Kojecký; Z. Coufal
Authors‘ workplace: Interní klinika IPVZ Praha, Krajská nemocnice T. Bati, a. s., Zlín, přednosta doc. MUDr. Čestmír Číhalík, CSc.
Published in: Vnitř Lék 2007; 53(2): 147-150
Category: Original Contributions

Overview

Patient set and methodology:
The authors evaluated the incidence of acute bleeding from the upper gastrointestinal tract in 5,955 patients (of which 3,684 men and 2,271 women) during hospitalisation for coronary angiography, and the incidence of

potential sources of bleeding from the upper gastrointestinal tract in the patients without bleeding.

Results:
Bleeding occurred in 9 persons, within 3.4 ± 3.6 days of the coronary angiography (the median of 1.0 day), with a 33 % mortality rate. An ulcer of the duodenal bulbus or bulbitis were detected in four cases (44 %), esophagitis in one case (11 %), esophageal varices in one case, stomach carcinoma in one case, and the source of bleeding could not be detected in 2 cases. Patients with bleeding were significantly older than those without bleeding (73.6 ± 4.4 years vs. 65.8 ± 10.6 years, p < 0.001). Treatment with clopidogrel or abciximab was not associated with a higher incidence of bleeding (p > 0.05). In 42 patients without bleeding, the following pathologies were detected by gastroscopy: esophagitis (31 %), mouth and stomach ulcers (36 %), duodenal ulcers (21 %), (12 %), esophageal varices (2 %) The incidence of mouth ulcers, stomach ulcers and duodenal ulcers was significantly higher in patients taking acetylsalicylic acid on a regular basis (p < 0.025).

Conclusion:
Bleeding from the upper gastrointestinal tract is not frequent shortly after coronary angiography, but the related mortality is high. The most frequent source of bleeding are duodenal peptic lesions most likely caused by previous treatment by acetylsalicylic acid.

Key words:
bleeding from gastrointestinal tract – coronary angiography – acetylsalicylic acid

Sources

1. Braunwald E, Altman EM, Beasley JW et al. ACC/AHA Guideline update for the management of patients with unstable angina and non-ST segment elevation myocardial infarction. Circulation 202; 106: 1893-1900.

2. Cook DJ, Fuller HJ, Guyatt GH et al. Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group. N Engl J Med 1994; 6: 377-381.

3. Cryer B. Reducing the risk of gastrointestinal bleeding with antiplatelet therapies. N Engl J Med 2005; 3: 287-289.

4. Derry S, Kong LY. Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis. BMJ 2000; 321: 1183-1187.

5. Dítě P et al. Akutní stavy v gastroenterologii. 1. ed. Praha: Galén 2005.

6. Huang JQ, Sridhar S, Hunt RH. Role of Helicobacter pylori infection and non-steroidal anti-inflamatory drugs in peptic-ulcer disease: a meta-analysis. The Lancet 2002; 359: 14-22.

7. Christenson JT, Schnuziger M, Maurice J et al. Gastrointestinal complications after coronary artery bypass grafting. J Thorac Cardiovasc Surg 1994; 108: 899-906.

8. Chan FKL, Ching JYL, Hung LCT et al. Clopidogrel versus Aspirin and Esomeprazole to Prevent Recurrent Ulcer Bleeding. N Engl J Med 2005; 352: 238-449.

9. Krč I, Krčová V. Antitrombotická léčba v etiologii akutní posthemoragické anémie. Vnitř Lék 2005; 51: 873- 877.

10. Lai KC, Lam SK, Chu KM et al. Lansoprasole for the prevention of recurrences of ulcer complications from long-term low-dose aspirin use. N Engl J Med 2002; 346: 2033-2038.

11. Lai KC, Chu KM, Hui WM et al. Esomeprazole with aspirin versus clopidogrel for prevention of recurrent gastrointestinal ulcer complications. Clin Gastroenterol Hepatol 2006; 7: 860-865.

12. Lanas A, Garcia-Rordigues LA, Arroyo M et al. Risk of upper gastrointestinal ulcer bleeding associated with selective COX-2 inhibitors, traditional non-aspirin NSAIDs, aspirin, and combinations. Gut 2006; 12: 1731-1738.

13. Ng FH, Wong SY, Chany CM et al. High incidence of clopidogrel-associated gastrointestinal bleeding in patients with previous peptic ulcer disease. Aliment Pharmacol Ther 2003; 4: 443-449.

14. Orford JL, Fasseas P, Melby S et al. Safety and efficacy of aspirin, clopidogrel, and warfarin after cornary stent placement in patients with an indication for anticoagulation. Am Heart J 2004; 3: 463-467.

15. Peters RJG, Mehta SR, Keith AA et al. Effect of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. Circulation 2003; 108: 1682-1687.

16. Rockall TA, Logan RFA, Delvin HB et al. Incidence and mortality from acute upper gastrointestinal hemorrhage in the United Kingdom. BMJ 1995; 311: 222-226.

17. Schuster DP, Eowley H, Feinstein S et al. Risk of the upper gastrointestinal bleeding after admission to a medical intensive care unit. Am J Med 1984; 4: 623-630.

18. Vergara M, Catalan M, Gisbert JP et al. Meta-analysis: role of Helicobacter pylori eradication in the prevention of peptic ulcer in NSAID users. Aliment Pharmacol Ther 2005; 12: 1411-1418.

19. Weil J, Collin-Jones D, Langman M et al. Prophylactic aspirin and risk of peptic ulcer bleeding. BMJ 1995; 310: 827-830.

20. Younossi ZM, Strum WB, Schatz RA et al. Effect of combined anticoagulation and low-dose aspirin treatment on upper gastrointestinal bleeding. Dig Dis Sci 1997; 1: 79-82.

21. Zacharias A, Schwann TA, Parenteau GL et al. Predictors of gastrointestinal complications in cardiac surgery. Tex Heart Inst J 2000; 33: 93-99.