Significant gastrointestinal bleeding in patients at risk of coronary stent thrombosis.
The evolution of drug-eluting stents (DES), effective periprocedural antithrombotic therapy, and advanced interventional techniques have fueled the surge of percutaneous coronary interventions. Stent thrombosis remains a serious complication of coronary artery stent implantation. Long-term antiplatelet therapy is required to prevent stent thrombosis, especially following DES implantation. Discontinuation of antiplatelet therapy (particularly clopidogrel) is the strongest independent risk factor for the development of stent thrombosis. Bleeding complications, most of which arise from the upper gastrointestinal (GI) tract, are the major limiting factors for antiplatelet therapy. The association of aspirin with the increased risk of upper GI bleeding has been well established. Peptic ulcer bleeding and Helicobacter pylori infection are the 2 most important risk factors for aspirin-associated GI bleeding complications. Endoscopy (for both surveillance and potential intervention), performed either emergently or semi-electively, is the primary tool for definitive management of GI bleeding. Considering the increase in GI bleeding risk seen with prolonged antiplatelet therapy, adjunctive proton pump inhibitor therapy and/or eradication of H. pylori infection might be beneficial for DES patients on long-term antiplatelet therapy.
Division of Cardiology, North Shore-Long Island Jewish Health System, New Hyde Park, New York, USA.
Xuming
X
Dai
Amgad N
AN
Makaryus
John N
JN
Makaryus
Rajiv
R
Jauhar
D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000628:therapy*; D054855:Drug-Eluting Stents; D004381:Duodenal Ulcer / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy; D016099:Endoscopy, Gastrointestinal; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000382:microbiology; D016480:Helicobacter pylori / Q000472:pathogenicity; D006801:Humans; D010438:Peptic Ulcer Hemorrhage / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin