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


OBJECTIVE
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.


METHODS
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.


RESULTS
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.
Foley
P
P
University of Birmingham, Good Hope Hospital, Rectory Road, Sutton Coldfield, UK.
Foley
S
S
Kinnaird
T
T
Anderson
R A
RA
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D000925:Anticoagulants / Q000009:adverse effects; D003328:Coronary Thrombosis / Q000517:prevention & control*; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D005773:Gastroscopy; D006801:Humans; D009853:Omeprazole / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
D000925:Anticoagulants; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D009853:Omeprazole