Acetylsalicylic Acid Use in Patients with Acute Myocardial Infarction and Peptic Ulcer Bleeding

Cheung, Justin; Rajala, Jennifer; Moroz, Daniel; Zhu, Qiaohao; Stamm, Michael A.; Sandha, Gurpal

doi:10.1155/2009/509258

Cited by 14 publications

(15 citation statements)

References 15 publications

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“…Endoscopic haemostasis is commonly achieved using adrenaline, and cardiac patients may be at theoretical risk of hypertensive crises or arrthymias. 16 Current studies have not reported such occurrences, 3,4,12 and none of our patients experienced any complications. Despite the risks, endoscopy is likely to play an important role in managing this cohort.…”

Section: Discussionmentioning

confidence: 52%

“…Diagnostic yield is !79%, 14 ours was 80%, and based on endoscopic findings, increasing evidence suggests that antiplatelet therapy can be safely re-started within seven days of UGIH. 2,4,5 In our study, antiplatelets were safely re-introduced, with PPI cover, after a median of three days. The use of prophylactic PPIs can reduce the risk of UGIH in cardiac patients receiving antiplatelet therapy.…”

Section: Discussionmentioning

confidence: 71%

“…Few studies have described the continued use of antiplatelets in the acute cardiac care setting. 2,4 Determinants include low-risk findings at endoscopy and acute myocardial infarctions requiring PCI. 4 We found that patients with an STEMI, a PCI þ stent and a low pre-endoscopy Rockall score were more likely to have had one or more antiplatelet agents continued.…”

Section: Discussionmentioning

confidence: 99%

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Upper gastrointestinal haemorrhage in the acute cardiac care setting: antiplatelets and endoscopy

et al. 2012

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Upper gastrointestinal haemorrhage (UGIH) in cardiac patients receiving antiplatelets presents a difficult management problem. The aim of this study was to describe a series of cardiac inpatients receiving antiplatelets who underwent endoscopy for an acute UGIH. Cardiac inpatients receiving antiplatelets and requiring endoscopy for UGIH over an 18-month period were followed up. Forty-one patients were studied. Most patients (25 [61%]) presented with melaena. Antiplatelets were withheld in 34 (83%) patients; predominantly in those with higher pre-endoscopy Rockall scores (median, 4; interquartile range [IQR], 3-5 versus median, 3; IQR, 2-4; P < 0.05). Positive findings were identified at endoscopy in 80%. Duodenal ulcers were the most common lesion and adrenaline the most common method of haemostasis. Median time to first endoscopy was 0 (IQR, 0-1) days. Seven (17%) patients re-bled, median Rockall score was six (IQR, 4-8). Three (7%) patients experienced procedural complications, two patients became hypoxic and one patient died. Following endoscopy, antiplatelets were restarted after a median of three (IQR, 3-5) days. On discharge, 27/28 (96%) patients continued with antiplatelet and proton-pump inhibitor therapy. Thirty-day inpatient mortality was 7% (3 patients). One patient re-bled within six months of discharge. Endoscopy helped assess the risk of re-bleeding and timing of antiplatelet re-introduction in cardiac inpatients experiencing UGIH.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

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Upper gastrointestinal haemorrhage in the acute cardiac care setting: antiplatelets and endoscopy

et al. 2012

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“…These findings are inconsistent with the results of the present study; this may be due to the small number of patients in the aspirin and clopidogrel groups. Cheung et al (28) demonstrated that patients with AMI who are complicated by peptic ulcer hemorrhage should not continue aspirin where viable; whereas patients who are at low risk of peptic ulcers following PCI treatment should regard aspirin as the preferable choice.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of various continued antiplatelet therapies in patients who were administered DAPT following the implantation of drug-eluting stents and developed gastrointestinal hemorrhage

Guo

Wei

2016

Experimental and Therapeutic Medicine

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Abstract. Although an increasing number of patients accept dual antiplatelet therapy (DAPT) following implantation of drug-eluting stents (DES) for coronary heart disease (CHD), the proportion of patients with DAPT who subsequently develop gastrointestinal hemorrhage continues to increase. To ensure the clinical outcomes from DES, it is important to formulate a novel continued antiplatelet therapy for patients who were administered DAPT and subsequently develop gastrointestinal hemorrhage following DES implantation. The present study aimed to evaluate the effects of continued aspirin, clopidogrel or DAPT use on the incidence of clinical adverse events and gastrointestinal rebleeding in patients who received DAPT and subsequently developed gastrointestinal hemorrhage following implantation of DES for CHD. Between 2004 and 2010, 108 consecutive patients receiving DAPT developed gastrointestinal hemorrhage following DES implantation for CHD at Liuzhou General Hospital (Liuzhou, Guangxi). These patients were divided into three groups according to the novel antiplatelet therapy. The occurrence of major adverse cardiac events (MACE), including cardiac death, non-fatal myocardial infarction, heart failure or target vessel revascularization, net adverse clinical events (NACE), including major bleeding, stroke or MACE, and gastrointestinal rebleeding during clinical follow-up following the initial procedure were compared among these three groups. The results of this analysis demonstrated that the occurrence rate of MACE, NECE and gastrointestinal rebleeding was not significantly different among these groups (P>0.05). Furthermore, survival analysis was performed and although the survival curves of MACE and NECE were not significantly different among these groups, gastrointestinal rebleeding was demonstrated to be significantly different among the three groups (P<0.05), and continued aspirin or clopidogrel use was superior to continued DAPT. In conclusion, the results of the present study indicated that there were no significant differences in the clinical effectiveness and safety of continuing antiplatelet monotherapy or DAPT in patients who are administered DAPT and experience gastrointestinal hemorrhage following DES implantation. As for the prevention of recurrent bleeding, antiplatelet monotherapy was demonstrated to be superior to DAPT. Moreover, the treatment of patients who are administered DAPT and experience gastrointestinal hemorrhage following DES implantation must involve an evaluation of the risk of complications, including stent thrombosis, continuous bleeding and recurrent hemorrhage.

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“…Low dose acetylsalicylic acid administrations to prevent thrombotic stroke or myocardial infarction, also can cause gastrointestinal damage and GI complications. It is reported that, ulcers and erosions have been detected endoscopically in 47.8% of patients who received low dose ASA for more than three months (23)(24)(25)(26). The short-term administration of ASA has been reported to bring out a higher risk compared to long-term administration (27,28).…”

Section: Discussionmentioning

confidence: 99%

Atherosclerosis and acetylsalicylic acid are independent risk factors for hemorrhage in patients with gastric or duodenal ulcer

Özdil¹,

Coşar²,

Akkız³

et al. 2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Üst gastrointestinal (Gİ) endoskopide gastrik ve/veya duodenal ülser saptanan vakalarda ülser kanaması için risk faktörleri araştırıldı. Yöntemler: Üst Gİ endoskopisinde duodenum ve gastrik ülser saptanan 350 vakanın (226 Erkek, 124 Kadın) dosyalarından retrospektif analiz yapıldı. İncelenen 92 vakada endoskopi sırasında Gİ kanama saptanmıştı. Kanaması olan ve olmayan hastaların tümünde nonsteroidal antienflamatuvar ilaç (NSAID) ve asetil salisilik asit (ASA) kullanımı ile koroner arter hastalığı (KAH) varlığı araştırıldı. Sonuçlar Ki-kare testi ve lojistik regresyon analizi ile değerlendirildi. Bulgular: Vakaların yaş ortalaması 50.4±15.7 (25-82) yıl idi. Doksan iki vakada (%26) gastrik veya duodenal ülsere bağlı kanama görüldü. Kanamalı hastalarda yaş ortalaması 64.6±11.4/ yıl, kanama olmayanlarda 45.7±13.9/yıl idi. Ülser kanaması olan vakalarda ASA kullanımı daha fazlaydı (NSAID, n=35 (%40); ASA, n=51 (%60); p=0.035). Ülseri olan kadınların %20'sinde kanama görülürken, erkeklerin %28'inde kanama görül-dü (p=0.055). Kanama riski KAH'lı vakalarda (OR:24.75, %95 güven aralığı (GA)=1.6-96.7, p=0.001), ASA (OR:9.76, %95 GA=2.1-37.5, p=0.021), NSAID (OR:4.72, %95 GA=1.1-16.5 p=0.032), yaş (OR:11.59, %95 GA=2.7-12.1, p=0.001), erkek cinsiyet için (OR:2.56, %95 GA=0.8, 9.6, p=0.052) olarak belirlendi. Sonuç: İleri yaş, ateroskleroz, erkek cinsiyet ve NSAİD (özellikle aspirin) kullanımı gastrik ve/veya duodenal ülserli hastalarda üst Gİ kanaması bakımından majör risk faktörleridir. (Anadolu Kardiyol Derg 2011 1: 53-6) Anahtar kelimeler: Aspirin, koroner arter hastalığı, üst gastrointestinal kanama, nonsteroidal anti-inflamatuvar ilaç, lojistik regresyon analizi ABSTRACT Objective: Risk factors for hemorrhage due to gastric and/or duodenal ulcer in patients diagnosed by upper gastrointestinal (GI) endoscopy were investigated in the present study. Methods: Medical records of 350 patients (226 males, 124 females) diagnosed as duodenal or gastric ulcers by GI endoscopy in the gastroenterology clinic were scanned retrospectively. Upper GI hemorrhage was detected in 92 patients by upper endoscopic examination. The medical history of non-steroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (ASA) usage and the presence of coronary artery disease (CAD) were investigated in all patients with or without hemorrhage. Results were evaluated by Chi-square test and logistic regression analysis. Results: The mean age of the patients was 50.4±15.7 years (range: 25 to 82 years). Hemorrhage due to gastric or duodenal ulcer was identified in 92 patients (26%). Mean age was 64.6±11.4 years in patients with hemorrhage and 45.7±13.9 years in patients without hemorrhage. ASA usage was more common than NSAID in patients with ulcer hemorrhage (NSAID usage n=35 (40%); ASA usage n=51 (60%); p=0.035). Hemorrhage was reported in 20% of the females and in 28% of the males who have ulcer (p=0.055). Risk factors for hemorrhage were CAD (OR:24.75, 95% CI=1.6-96.7, p=0.001), ASA usage (OR:9.76, 95% CI=2.1-37.5, p=0.021), NSAID us...

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Acetylsalicylic Acid Use in Patients with Acute Myocardial Infarction and Peptic Ulcer Bleeding

Cited by 14 publications

References 15 publications

Upper gastrointestinal haemorrhage in the acute cardiac care setting: antiplatelets and endoscopy

Upper gastrointestinal haemorrhage in the acute cardiac care setting: antiplatelets and endoscopy

Clinical outcomes of various continued antiplatelet therapies in patients who were administered DAPT following the implantation of drug-eluting stents and developed gastrointestinal hemorrhage

Atherosclerosis and acetylsalicylic acid are independent risk factors for hemorrhage in patients with gastric or duodenal ulcer

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