In‐hospital gastrointestinal bleeding following percutaneous coronary intervention

Kwok, Chun Shing; Sirker, Alex; Farmer, Adam D.; Kontopantelis, Evangelos; Potts, Jessica; Haq, Muhammad Ayyaz Ul; Ludman, Peter; Belder, Mark de; Townend, Jonathan N.; Zaman, Azfar; Large, Adrian; Kinnaird, Tim; Mamas, Mamas A.

doi:10.1002/ccd.28222

Cited by 7 publications

(6 citation statements)

References 30 publications

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“…Stent placement is a significant risk factor for new gastrointestinal bleeding, with a risk between 1.3% and 2.4% for GI bleeding within 30 days of ACS in patients on dual antiplatelet therapy (DAPT) [1,2]. Gastrointestinal bleeding following ACS is associated with increased morbidity and mortality [3][4][5][6][7][8]. Fecal occult blood testing (FOBT) has been used in studies in an attempt to predict the need for DAPT discontinuation and assess the bleeding risk of DAPT [9,10].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Hospitalized Patients With Fecal Occult Positive Stool Prior to Cardiac Catheterization in Acute Coronary Syndrome (ACS)

Searls¹,

Annie²,

Tomanguillo³

et al. 2023

Cureus

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IntroductionCardiac catheterization is an essential component of patient care in Acute Coronary Syndrome (ACS). Fecal occult blood testing (FOBT) has been used in the inpatient setting to evaluate the risk of bleeding with dual anti-platelet therapy prior to cardiac catheterization although no guidelines exist for this indication and FOBT testing in the inpatient setting is not recommended for evaluation of GI blood loss. We sought to assess the outcomes of patients with fecal occult positive stool prior to cardiac catheterization compared to those that did not undergo FOBT during admission for non-ST-elevation myocardial infarction (NSTEMI). MethodsWe identified patients between 18 and 90 years old with admission for NSTEMI in the Trinetx Research Network from January 1, 2019 to December 31, 2020. Patients were then divided into those who had an FOBT prior to cardiac catheterization and those that did not have an FOBT. We compared all-cause mortality, bleeding, troponin levels, and length of stay between propensity-matched (PSM) pairs of patients. ResultsWe identified 46,349 that met inclusion criteria, of which 1,728 had an FOBT (3.7%) and 44,621 (96.3%) had no FOBT prior to cardiac catheterization. Patients in the FOBT group were older and had a higher prevalence of hypertension, coronary artery disease, heart failure, diabetes, chronic obstructive pulmonary disease, and higher BMI. Two well-matched groups of n=1,728/1,728 were used for comparing outcomes. The FOBT group had similar 30-day mortality (4.45% vs 4.01, P=0.56) as well as similar bleeding events (0.98% vs 0.69%, P=0.35). Troponin levels in the FOBT group were on average lower (0.41 vs 0.95, P=0.04). The FOBT groups also had a similar average length of stay of (14.1 days vs 14.2 days, P=0.42). 233 patients who received FOBT underwent endoscopic evaluation with either upper endoscopy or colonoscopy (13.5%), and there was no significant difference in 30-day mortality (6.86% vs 4.7%, P=0.321). Among patients who underwent endoscopy, 72 had some form of endoscopic intervention (30.9%). There was no difference in 30-day mortality between patients undergoing endoscopy with intervention and without intervention (14.49%/14.49%) P=1.00. Readmission was similar between patients undergoing endoscopy with and without intervention. ConclusionsIn a large multi-center national database, we observed similar outcomes in patients who were admitted with NSTEMI and had FOBT and those not receiving FOBT in terms of all-cause mortality and bleeding events. In patients with positive FOBT, endoscopy with and without intervention we observed no significant difference in 30-day mortality. We conclude that there is no compelling evidence for FOBT testing in patients with NSTEMI.

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Section: Introductionmentioning

confidence: 99%

Outcomes of Hospitalized Patients With Fecal Occult Positive Stool Prior to Cardiac Catheterization in Acute Coronary Syndrome (ACS)

Searls¹,

Annie²,

Tomanguillo³

et al. 2023

Cureus

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“… 5 , 6 However, abundant evidence showed that the high incidence of bleeding is mainly concentrated within 1 week of the disease course. 7 Hence, it is important to choose the appropriate medications to prevent GI bleeding. It is recommended that patients with myocardial infarction take proton pump‐inhibitors (PPIs) or H2 receptor antagonists (H2RAs) at the same time as antithrombotic therapy.…”

Section: Introductionmentioning

confidence: 99%

“…But the application of combined antiplatelet therapy also has its disadvantages, which is to increase the incidence of gastrointestinal (GI) complications, such as ulcers and GI bleeding 5,6 . However, abundant evidence showed that the high incidence of bleeding is mainly concentrated within 1 week of the disease course 7 . Hence, it is important to choose the appropriate medications to prevent GI bleeding.…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of the short‐term combination therapy with ticagrelor and PPIs or H2RA in patients with acute STEMI who underwent emergency PCI

Wei

Zhuo

et al. 2021

Clinical Translational Sci

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Combination therapy with platelet inhibitors and acid‐suppressive agents is recommended for patients with acute ST‐segment elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI), but there remains a paucity of data to evaluate both the efficacy and safety of these combinations. In this prospective study, a total of 170 patients with acute STEMI who underwent PCI were divided into four groups: pantoprazole + ticagrelor, omeprazole + ticagrelor, ranitidine + ticagrelor, and ticagrelor only. The risk of PCI, antithrombotic efficacy, cardiac function, and main end points were evaluated and compared. No significant differences were found in infarction‐related artery perfusion indexes (thrombolysis in myocardial infarction [TIMI], corrected TIMI frame count), the incidence of stent thrombosis after PCI, platelet indicators (platelet count, mean platelet volume, and platelet distribution width), platelet activation (P‐selectin and glycoprotein IIb/IIIa levels), platelet aggregation (thrombelastography indicators, such as ADP% and MAADP), myocardial necrosis biomarker (creatine kinase isoenzyme‐MB and cardiac troponin I) levels, brain natriuretic peptide levels, the incidence of ischemic end point events, and the incidence of other tissue and organ bleeding events among the four groups. The incidence of gastrointestinal (GI) bleeding events in the proton pump‐inhibitor (PPI) group was significantly lower than that in the control group, whereas in the H2 receptor antagonist (H2RA) group it was not significantly different from the control group. The short‐term combination therapy with ticagrelor and PPIs or H2RA is safe and effective in patients with acute STEMI after PCI. In addition, the PPIs combined with ticagrelor could reduce the incidence of GI bleeding events without increasing the incidence of ischemic events.

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“…GIB is one of the complications of patients admitted to cardiology, which is common in acute myocardial infarction [1], percutaneous coronary intervention (PCI) [2]and anticoagulant or antiplatelet drugs [3]. Not only the length of stay and hospitalization expenses increased, but also lead to other organ dysfunction or even failure, and may cause death in severe cases.…”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal Bleeding in Patients Admitted to Cardiology: risk factors and a new risk score

Zhang

Liu

Wang

et al. 2020

Preprint

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Background: Although the early use of a risk stratification score in gastrointestinal bleeding(GIB) is recommended, there has been no risk score for GIB in patients admitted to cardiology so far.Objective:To describe the risk factors of GIB and develop a new risk score model in patients admitted to cardiology. Methods: A total of 633 inpatients with GIB from January 2014 to December 2018 were recruited, 4,231 inpatients with non-GIB recruited as the control group. Multivariate logistic regression was used to describe the risk factors of GIB,A new risk score model was developed in the derivation cohort. Accuracy to predict GIB was assessed by the area under the receiver operating characteristic (AUROC) curve in the validation cohort.Results: Male, coronary heart disease, hypertension, stroke, systolic blood pressure, hematocrit, plasma albumin and alanine aminotransferase(ALT) were associated with GIB . The model had a high predictive accuracy (AUROC 0.816; 95%CI, 0.792-0.839), which was supported by the validation cohort (AUROC 0.841; 95% CI, 0.807~0.874). Besides,the prediction of the model better than HAS-BLED score(AUROC 0.557; 95%CI, 0.513~0.602) and CRUSADE score(AUROC 0.791; 95%CI, 0.757~0.825), respectively. Among the inpatients with a score 0-3, 4-7, and ≥8 points, the incidence of GIB, the proportion of inpatients requiring suspended red blood cells transfusion, length of stay and in-hospital mortality all increased gradually(P< 0.001). Conclusions: Male, coronary heart disease, hypertension, stroke, systolic blood pressure, hematocrit, plasma albumin and ALT are associated with GIB. The new risk score model is an accurate risk score that predicts GIB in patients admitted to cardiology.

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In‐hospital gastrointestinal bleeding following percutaneous coronary intervention

Cited by 7 publications

References 30 publications

Outcomes of Hospitalized Patients With Fecal Occult Positive Stool Prior to Cardiac Catheterization in Acute Coronary Syndrome (ACS)

Outcomes of Hospitalized Patients With Fecal Occult Positive Stool Prior to Cardiac Catheterization in Acute Coronary Syndrome (ACS)

The efficacy and safety of the short‐term combination therapy with ticagrelor and PPIs or H2RA in patients with acute STEMI who underwent emergency PCI

Gastrointestinal Bleeding in Patients Admitted to Cardiology: risk factors and a new risk score

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