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QJM Advance Access published online on January 21, 2008
QJM, doi:10.1093/qjmed/hcm112
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© The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Clinical review: gastrointestinal bleeding after percutaneous coronary intervention: a deadly combination

P. Foley1, S. Foley2, T. Kinnaird3 and R.A. Anderson3

From the 1University of Birmingham, Good Hope Hospital, Rectory Road, Sutton Coldfield, B75 7RR, 2Wolfson Digestive Disease Centre, University of Nottingham, C Floor, South Block, Queens Medical Centre, Nottingham NG7 2UH and 3Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK

Address correspondence to: Dr Richard Anderson, Consultant Interventional Cardiologist. email: Richard.Anderson{at}uhw.cardiffandvale.wales.nhs.uk


  Abstract

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.

Conclusions: 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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