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

Abstract

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.

The Incidence and Risk Factors of Acute Myocardial Infarction Among Patients with Gastrointestinal bleeding: A Retrospective Study

“…Dual antiplatelet therapy can significantly reduce mortality, the incidence of adverse ischemic events, short-term and long-term complications after PCI and the incidence of other major adverse cardiovascular events, but it also undoubtedly increases the risk of GIB. 14 , 15 It has been reported that the incidence of in-hospital GIB in patients with AMI was 1.19%, even up to 10.4% within 4 years in STEMI patients after primary PCI. 16 , 17 Severe bleeding after acute coronary syndrome (ACS) can increase the mortality by 5 times, GIB was an independent predictor of mortality in patients with AMI.…”

Randomised controlled trial of early magnetically controlled capsule endoscopy for the prevention of gastrointestinal bleeding in patients at high bleeding risk scheduled for percutaneous coronary intervention: MACE-GPS study protocol

“…The controller allows movements of 2 mm and changes the viewing angle by 3° in a three-dimensional space. More recently, multicentre studies have demonstrated that MCE controlled by a robot magnet achieved 93.4% accuracy in detecting focal lesions in the stomach compared with standard gastroscopy 24 30…”

A Small Bowel Ulcer due to Clopidogrel with Cytomegalovirus Enteritis Diagnosed by Capsule and Double-Balloon Endoscopy

“…Clopidogrel is a platelet aggregation inhibitor used for the treatment of acute coronary syndrome and chronic vascular stenosis. While dual antiplatelet therapy decreases cardiovascular events after successful coronary drug-eluting stenting, it is considered to increase the risk of gastrointestinal bleeding [ 1 ]. There are no previous reports of small bowel injury due to clopidogrel.…”