Key result
Early endoscopy cuts hemorrhage control failure ~81% vs medical therapy in ACS with upper GI bleeding.
Why the study?
Acute upper gastrointestinal bleeding is not uncommon in acute coronary syndrome patients, particularly under DAPT, but the efficacy and safety of early endoscopy in these patients needed to be elucidated.
Does early endoscopy improve control of hemorrhage in patients with recent acute coronary syndrome presenting with acute upper gastrointestinal bleeding?
RCT (n=43)
Computer generated randomization number
Yes
Does early endoscopy improve control of hemorrhage in patients with recent acute coronary syndrome presenting with acute upper gastrointestinal bleeding?
In patients with recent acute coronary syndrome, early endoscopy for acute upper gastrointestinal bleeding significantly improves bleeding control and reduces transfusion needs without increasing overall mortality, though male patients may face higher complication risks.
Answers are grounded in this paper and cite their sources.
Supports early endoscopy over medical therapy alone for hemorrhage control in ACS with UGIB; extends RCT evidence to this high-risk population.
Acute upper gastrointestinal bleeding (UGIB) in acute coronary syndrome (ACS) patients are not uncommon, particularly under dual antiplatelet therapy (DAPT). Whether early endoscopy (EE) for UGIB in these patients is efficient and safe needs to be elucidated. This multicenter randomized controlled trial randomized recent ACS patients presenting acute UGIB to non-EE and EE groups. All eligible patients received intravenous proton pump inhibitor therapy. Those in EE group underwent therapeutic endoscopy within 24 hours after bleeding. The data regarding efficacy and safety of EE were analyzed. In total, 43 patients were randomized to non-EE (21 patients) and EE (22 patients) groups. The failure rate of control hemorrhage (4.55% vs. 23.81%, p<0.001) and 3-day rebleeding rate (4.55% vs. 28.57%, p=0.033) were lower in EE than non-EE group. The mortality, minor and major complication rates were not different between two groups. Male patients were at higher risk of minor and major complications after EE with OR (95%CI) of 3.50 (1.15~10.63) and 4.25 (1.43~12.63), respectively. In multivariate analysis, EE was associated with lower needs for blood transfusion (HR 0.13, 95%CI 0.02~0.98). Among patients who discontinued DAPT during acute UGIB, a higher risk (OR 5.25, 95%CI 1.21~22.74) of coronary artery stent re-thrombosis within 6 months was noticed. EE for acute UGIB in recent ACS patients has higher rate of bleeding control, lower 3-day rebleeding rate and lower needs for blood transfusion, but more complications in male patients. (ClinicalTrial.gov Number NCT02618980, registration date 02/12/2015)
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Chung et al. (2022) conducted an RCT in Acute upper gastrointestinal bleeding in acute coronary syndrome (n=43). Early endoscopy vs. Non-early endoscopy (pharmacological therapy alone with PPIs) was evaluated on Failure of control hemorrhage within 24 hours (p=0.0002). Early endoscopy significantly reduced the failure rate of hemorrhage control to 4.55% compared to 23.81% with pharmacological therapy alone in patients with acute coronary syndrome and upper gastrointestinal bleeding.
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