title: Upper gastrointestinal haemorrhage in the acute cardiac care setting: antiplatelets and endoscopy.
abstract: Upper gastrointestinal haemorrhage (UGIH) in cardiac patients receiving antiplatelets presents a difficult management problem. The aim of this study was to describe a series of cardiac inpatients receiving antiplatelets who underwent endoscopy for an acute UGIH. Cardiac inpatients receiving antiplatelets and requiring endoscopy for UGIH over an 18-month period were followed up. Forty-one patients were studied. Most patients (25 [61%]) presented with melaena. Antiplatelets were withheld in 34 (83%) patients; predominantly in those with higher pre-endoscopy Rockall scores (median, 4; interquartile range [IQR], 3-5 versus median, 3; IQR, 2-4; P < 0.05). Positive findings were identified at endoscopy in 80%. Duodenal ulcers were the most common lesion and adrenaline the most common method of haemostasis. Median time to first endoscopy was 0 (IQR, 0-1) days. Seven (17%) patients re-bled, median Rockall score was six (IQR, 4-8). Three (7%) patients experienced procedural complications, two patients became hypoxic and one patient died. Following endoscopy, antiplatelets were restarted after a median of three (IQR, 3-5) days. On discharge, 27/28 (96%) patients continued with antiplatelet and proton-pump inhibitor therapy. Thirty-day inpatient mortality was 7% (3 patients). One patient re-bled within six months of discharge. Endoscopy helped assess the risk of re-bleeding and timing of antiplatelet re-introduction in cardiac inpatients experiencing UGIH.
authors.affiliation: Department of Gastroenterology and Hepatology, St George's Hospital, London, England,  UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Musa
authors.forename: S J
authors.initials: SJ
authors.lastname: Brecker
authors.forename: T M
authors.initials: TM
authors.lastname: Rahman
authors.forename: J Y
authors.initials: JY
authors.lastname: Kang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004334:Drug Administration Schedule; D004381:Duodenal Ulcer / Q000150:complications* / Q000401:mortality; D016099:Endoscopy, Gastrointestinal; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy / Q000401:mortality; D006331:Heart Diseases / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008551:Melena / Q000139:chemically induced; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D041742:Upper Gastrointestinal Tract / Q000187:drug effects*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D010975:Platelet Aggregation Inhibitors; D014662:Vasoconstrictor Agents; D004837:Epinephrine