Risk and management of upper gastrointestinal bleeding associated with prolonged dual-antiplatelet therapy after percutaneous coronary intervention.
Prolonged dual-antiplatelet therapy with aspirin and clopidogrel is mandatory after drug-eluting stent implantation because of the potential increased risk of late stent thrombosis. The concern regarding prolonged antiplatelet therapy is the increased risk of bleeding. Gastrointestinal bleeding is the most common site of bleeding and presents a serious threat to patients due to the competing risks of gastrointestinal hemorrhage and stent thrombosis. Currently, there are no guidelines and little evidence on how best to manage these patients who are at high risk of morbidity and mortality from both the bleeding itself and the consequences of achieving optimum hemostasis by interruption of antiplatelet therapy. Managing gastrointestinal bleeding in a patient who has undergone recent percutaneous coronary intervention requires balancing the risk of stent thrombosis against further catastrophic bleeding. Close combined management between gastroenterologist and cardiologist is advocated to optimize patient outcomes.
Tan
Victoria P
VP
Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia.
Yan
Bryan P
BP
Kiernan
Thomas J
TJ
Ajani
Andrew E
AE
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects; D001803:Blood Transfusion; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000628:therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D016099:Endoscopy, Gastrointestinal; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000628:therapy*; D016480:Helicobacter pylori / Q000187:drug effects / Q000254:growth & development; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D018570:Risk Assessment; D015607:Stents; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives
D000890:Anti-Infective Agents; D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin