title: Investigation of upper gastrointestinal bleeding after implantation of drug-eluting stents; prospective cohort study.
abstract: OBJECTIVE
  After implantation of drug-eluting stents (DES), two or more anti-thrombotic agents are required. The risk of upper gastrointestinal bleeding (UGIB) in cases of DES implantation is thought to be significant. However, the incidence of UGIB has not yet been investigated in DES-implanted patients. This study aimed to investigate the incidence of UGIB after DES implantation and the awareness among cardiologists about this complication.
  
  
  METHODS
  Subjects were 397 consecutive patients implanted with DES from August 2004 to September 2007 at two institutions. Endoscopic examinations were performed on DES-implanted patients who presented with hematemesis and/or tarry stools. The concomitant use of acid-suppressing agents was left to the cardiologists. In addition, 37 cardiologists were administered a questionnaire regarding UGIB after DES implantation.
  
  
  RESULTS
  Low-dose aspirin and ticlopidine were prescribed in all patients. Forty-six patients had a past history of peptic ulcer. Acid-suppressing agents were concomitantly prescribed to 224 patients (56%) including 32 patients (70%) with a past history of peptic ulcer. UGIB due to gastric ulcers developed in 5 cases (1.3%). One case had received a half dose of H2-RA. No bleeding occurred in patients who received proton pump inhibitors (PPI). The incidence of UGIB was 4.0 per 1000 patient-years. The cardiologists who were surveyed recognized the risk of UGIB after DES implantation and the necessity for its prevention. However, they indicated that adequate management for preventing this complication has not been established.
  
  
  CONCLUSIONS
  This study reassuringly demonstrated a low incidence of UGIB after DES implantation. Further study regarding the prophylaxis for UGIB after DES implantation is necessary.
authors.affiliation: Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Fukuyama, Hiroshima, Japan. toyotatu@kmail.plala.or.jp
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Toyokawa
authors.forename: Tomoki
authors.initials: T
authors.lastname: Inaba
authors.forename: Shigenao
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Morihito
authors.initials: M
authors.lastname: Nakatsu
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ando
authors.forename: Jun
authors.initials: J
authors.lastname: Tomoda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology*; D006396:Hematemesis / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008551:Melena / Q000139:chemically induced / Q000453:epidemiology; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents