[Clinically manifest gastrointestinal bleeding in patients subject to coronary angiography].
PATIENT SET AND METHODOLOGY: The authors evaluated the incidence of acute bleeding from the upper gastrointestinal tract in 5,955 patients (of which 3,684 men and 2,271 women) during hospitalisation for coronary angiography, and the incidence of potential sources of bleeding from the upper gastrointestinal tract in the patients without bleeding.


RESULTS
Bleeding occurred in 9 persons, within 3.4 +/- 3.6 days of the coronary angiography (the median of 1.0 day), with a 33% mortality rate. An ulcer of the duodenal bulbus or bulbitis were detected in four cases (44%), esophagitis in one case (11%), esophageal varices in one case, stomach carcinoma in one case, and the source of bleeding could not be detected in 2 cases. Patients with bleeding were significantly older than those without bleeding (73.6 +/- 4.4 years vs. 65.8 +/- 10.6 years, p < 0.001). Treatment with clopidogrel or abciximab was not associated with a higher incidence of bleeding (p > 0.05). In 42 patients without bleeding, the following pathologies were detected by gastroscopy: esophagitis (31%), mouth and stomach ulcers (36%), duodenal ulcers (21%), (12%), esophageal varices (2%) The incidence of mouth ulcers, stomach ulcers and duodenal ulcers was significantly higher in patients taking acetylsalicylic acid on a regular basis (p < 0.025).


CONCLUSIONS
Bleeding from the upper gastrointestinal tract is not frequent shortly after coronary angiography, but the related mortality is high. The most frequent source of bleeding are duodenal peptic lesions most likely caused by previous treatment by acetylsalicylic acid.
Kojecký
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Interni klinika IPVZ, Krajská nemocnice T Bati, a.s., Zlín. kojecky@bnzlin.cz
Coufal
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Z
D000077284:Abciximab; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D000925:Anticoagulants / Q000009:adverse effects; D000077144:Clopidogrel; D017023:Coronary Angiography / Q000009:adverse effects*; D004381:Duodenal Ulcer / Q000150:complications; D004941:Esophagitis / Q000150:complications; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000209:etiology*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D013276:Stomach Ulcer / Q000150:complications; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D000077284:Abciximab