Key result
Gastrointestinal bleeding complicates 2.3% of primary angioplasty cases and carries a 10% mortality rate, necessitating individualized management to balance bleeding and stent thrombosis risks.
Why the study?
How should gastrointestinal bleeding be managed in patients who have recently undergone percutaneous coronary intervention to balance the risks of bleeding and stent thrombosis?
How should gastrointestinal bleeding be managed in patients who have recently undergone percutaneous coronary intervention to balance the risks of bleeding and stent thrombosis?
Managing GI bleeding after recent PCI requires individualized care balancing the high mortality of bleeding against the risk of acute stent thrombosis if anti-platelet therapy is ceased.
Requires individualized antithrombotic management post-PCI GI bleed to balance mortality and thrombosis risks; leaves open optimal strategies pending prospective trials.
BACKGROUND: Managing gastrointestinal bleeding in a patient who has undergone recent percutaneous coronary intervention requires balancing the risk of stent thrombosis against further catastrophic bleeding. Stent thrombosis and severe gastrointestinal bleeding are life-threatening complications. AIMS: To evaluate the risks of gastrointestinal bleeding in patients undergoing percutaneous coronary intervention in relation to anti-platelet therapy and to discuss management of gastrointestinal bleeding in these patients. DESIGN: Review of published studies comparing anti-platelet and ulcer healing therapy. A review of the evidence surrounding the management of gastrointestinal bleeding and the need for anti-platelet therapy in patients undergoing percutaneous coronary intervention. FINDINGS: Gastrointestinal bleeding is relatively common after percutaneous coronary intervention. In one study it complicated 2.3% of primary angioplasty, and these patients had a mortality of 10%. Recent registry data of patients experiencing a gastrointestinal bleed reported a mortality of 5.4%. Cessation of anti-platelet therapy carries a high risk of acute stent thrombosis, which has a high mortality. CONCLUSION: Individualized specialist gastrointestinal and cardiological management of these patients in a high dependency environment is recommended. Supportive care and proton pump inhibition in combination with judicious use of anti-platelet therapy is likely to provide the best balance of risk.
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Foley et al. (2008) conducted a review in Gastrointestinal bleeding after percutaneous coronary intervention. Anti-platelet therapy was evaluated on Mortality associated with gastrointestinal bleeding. Gastrointestinal bleeding complicates 2.3% of primary angioplasty cases and carries a 10% mortality rate, necessitating individualized management to balance bleeding and stent thrombosis risks.
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