Is There an Optimal Antiplatelet Strategy after Gastrointestinal Bleeding in Patients with Coronary Artery Disease?

Abstract

Gastrointestinal bleeding after percutaneous coronary intervention (PCI) is a not too uncommon clinical situation and is associated with high morbidity and mortality. After initial treatment, a number of clinical decisions must be made weighing the risks of ischemic events and future bleeding. In particular, healthcare providers must carefully balance the effectiveness of antiplatelet therapy in the secondary prevention of coronary events, primarily future spontaneous myocardial infarction and stent thrombosis, against the risk of major, most commonly gastrointestinal bleeding. The first question is whether a dual antiplatelet therapy strategy is required or if a single antiplatelet agent will suffice. Then, if a single antiplatelet agent is adequate, which agent should be continued. Although there is some guidance to answer some of these questions, there are inadequate evidence-based data for others. Below, we review the various considerations and summarize our approach and rationale to manage patients who had gastrointestinal bleeding after PCI.

Prevalence of Acute Gastro Intestinal Tract Bleeding in Patients Undergoing Primary Percutaneous Coronary Intervention After Acute Myocardial Infarction

“…The usefulness of antiplatelet therapy in the secondary prevention of cardiac events, especially sudden myocardial infarction and early stent thrombosis, must be carefully balanced against the risk of severe acute gastrointestinal tract bleeding. 19,20,21…”