title: Proton-pump inhibitors can decrease gastrointestinal bleeding after percutaneous coronary intervention.
abstract: BACKGROUND
  Current medical therapies for patients who have an acute coronary syndrome (ACS) focus on the coagulation cascade and platelet inhibition. These, coupled with early use of cardiac catheterization and revascularization, have decreased morbidity and mortality rates in patients who have acute ischemic heart disease with risk of bleeding.
  
  
  OBJECTIVE
  The study aimed to determine the incidence of gastrointestinal bleeding after percutaneous coronary intervention (PCI). The effect of proton-pump inhibitor (PPI) treatment was also analyzed.
  
  
  METHODS
  This case-control study evaluated gastrointestinal bleeding within a year of PCI for stable angina and acute coronary syndromes at Nanjing First Hospital between 2008 and 2011. Cases were identified and outcomes assessed using linkage analysis of data from cardiology and gastroenterology department databases. Analysis of the case and control groups for both risk and protective factors was performed using independent two-sample Student's t-test with Fisher's exact P value and logistic regression.
  
  
  RESULTS
  The incidence of gastrointestinal bleeding following PCI was 1.3% (35/2680 patients). The risk factors for gastrointestinal bleeding were advanced age, female gender, smoking, drinking, previous peptic ulcer and previous gastrointestinal bleeding. PPI use after PCI (P=0.000) was accompanied by a lower risk of gastrointestinal bleeding, with only a few cases of gastrointestinal bleeding events reported.
  
  
  CONCLUSIONS
  The incidence of gastrointestinal bleeding associated with the combination of aspirin and clopidogrel therapy was estimated to be 1.3%. Advanced age, being female, smokers, drinkers, previous peptic ulcer and previous gastrointestinal bleeding were significant independent risk factors. PPI for the prevention and treatment of gastrointestinal bleeding induced by the combination of aspirin and clopidogrel in patients after PCI was safe and effective.
authors.affiliation: Department of Gastroenterology, Nanjing First Hospital Affiliated to Nanjing Medical University, 68, Changle Road, Nanjing 210006, China.
authors.forename: Zongdan
authors.initials: Z
authors.lastname: Jiang
authors.forename: Hailu
authors.initials: H
authors.lastname: Wu
authors.forename: Zhaotao
authors.initials: Z
authors.lastname: Duan
authors.forename: Zhibing
authors.initials: Z
authors.lastname: Wang
authors.forename: Kewei
authors.initials: K
authors.lastname: Hu
authors.forename: Fei
authors.initials: F
authors.lastname: Ye
authors.forename: Zhenyu
authors.initials: Z
authors.lastname: Zhang
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D060050:Angina, Stable / Q000628:therapy; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D016022:Case-Control Studies; D000077144:Clopidogrel; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D008297:Male; D010437:Peptic Ulcer / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin