Details

Autor(en) / Beteiligte

• Casado Arroyo, Rubén
• Polo-Tomas, Mónica
• Roncalés, Maria P
• Scheiman, James
• Lanas, Ángel

Titel

Lower GI bleeding is more common than upper among patients on dual antiplatelet therapy: long-term follow-up of a cohort of patients commonly using PPI co-therapy

Ist Teil von

• Heart (British Cardiac Society), 2012-05, Vol.98 (9), p.718-723

Ort / Verlag

London: BMJ Publishing Group Ltd and British Cardiovascular Society

Erscheinungsjahr

2012

Quelle

BMJ Journals Archiv - DFG Nationallizenzen

Beschreibungen/Notizen

• ObjectivePatients undergoing percutaneous coronary intervention require dual antiplatelet therapy. Proton-pump inhibitor (PPI) therapy is recommended for the prevention of upper GI complications. No study has determined the rate and type of GI bleeding events in such patients in routine clinical practice.DesignObservational study with a prospective follow-up to confirm medication use and occurrence of events, which were validated.Patients and settingWe have followed up a cohort of 1219 consecutive patients admitted for percutaneous coronary intervention in Zaragoza (Spain).Main outcome measuresMajor GI bleeding and cardiovascular events.ResultsAt discharge, 96.7% of patients were on dual antiplatelet therapy and 76.6% on PPI therapy, which increased up to 87.9% during follow-up of 2107.6 patient (pt) s-years (1.72±1.07 years/patient). There were eight patients who developed GI bleeding during hospitalisation and 27 patients during follow-up, (1.52 bleeds per 100 pt-years). Most GI bleeding events (81.4%) occurred during the first year (mean time to bleeding event: 7.03±7.65 months) and 84.6% of patients were on long-term PPI at the time of the bleed. Lower GI bleeding occurred more frequently than upper GI bleeding (74% lower vs 26% upper). Peptic ulcer history and concomitant warfarin therapy were the only risk factors identified for upper or lower GI bleeding respectively.ConclusionsAmong patients on dual antiplatelet therapy and PPI co-therapy, gastrointestinal bleeding episodes are more frequent in the lower GI tract. This changing pattern of bleeding may reflect the success of gastroprotection and focuses attention on research to address lower GI bleeding in this population.