title: Outcome of acute upper gastrointestinal bleeding in patients with coronary artery disease: A matched case-control study.
abstract: OBJECTIVE
  The risk of upper gastrointestinal bleeding (UGIB) increases in patients with coronary artery disease (CAD) due to the frequent use of antiplatelets. There is some data reporting on treatment outcomes in CAD patients presenting with UGIB. We aim to determine the clinical characteristics and outcomes of UGIB in patients with CAD, compared with non-CAD patients.
  
  
  METHODS
  We conducted a prospective multi-center cohort study (THAI UGIB-2010) that enrolled 981 consecutive hospitalized patients with acute UGIB. A matched case-control analysis using this database, which was collected from 11 tertiary referral hospitals in Thailand between January 2010 and September 2011, was performed.
  
  
  RESULTS
  Of 981 hospitalized patients with UGIB, there were 61 CAD patients and 244 gender-matched non-CAD patients (ratio 1:4). UGIB patients with CAD were significantly older, and had more frequently used antiplatelets and warfarin than in non-CAD patients. Compared with non-CAD, the CAD patients had significantly higher Glasgow-Blatchford score, full and pre-endoscopic Rockall score and full. Peptic ulcer in CAD patients was identified more often than in non-CAD patients. UGIB patients with CAD and non-CAD had similar outcomes with regard to mortality rate, re-bleeding, surgery, embolization, and packed erythrocyte transfusion. However, CAD patients had longer duration of hospital stays than non-CAD patients. Two CAD patients died from cardiac arrest after endoscopy, whereas three non-CAD patients died from pneumonia and acute renal failure during their hospitalization.
  
  
  CONCLUSIONS
  In Thailand, patients presenting with UGIB, concomitant CAD did not affect clinical outcome of treatment, compared with non-CAD patients, except for longer hospital stay.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Kessarin
authors.initials: K
authors.lastname: Thanapirom
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Wiriyaporn
authors.initials: W
authors.lastname: Ridtitid
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Rungsun
authors.initials: R
authors.lastname: Rerknimitr
authors.affiliation: Division of Gastroenterology, Sawanpracharak Hospital, Nakhon Sawan, Thailand.
authors.forename: Rattikorn
authors.initials: R
authors.lastname: Thungsuk
authors.affiliation: Division of Gastroenterology, Surin Hospital, Surin, Thailand.
authors.forename: Phadet
authors.initials: P
authors.lastname: Noophun
authors.affiliation: Division of Gastroenterology, HRH Princess MahaChakriSirindhorn Medical Center-MSMC Hospital, Bangkok, Thailand.
authors.forename: Chatchawan
authors.initials: C
authors.lastname: Wongjitrat
authors.affiliation: Division of Gastroenterology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand.
authors.forename: Somchai
authors.initials: S
authors.lastname: Luangjaru
authors.affiliation: Division of Gastroenterology, Maharaj Nakhonsithammarat Hospital, Nakhonsithammarat, Thailand, Tailand.
authors.forename: Padet
authors.initials: P
authors.lastname: Vedkijkul
authors.affiliation: Division of Gastroenterology, Chonburi Hospital, Chonburi, Thailand.
authors.forename: Comson
authors.initials: C
authors.lastname: Lertkupinit
authors.affiliation: Division of Gastroenterology, Bangkok Hospital, Bangkok, Thailand.
authors.forename: Swangphong
authors.initials: S
authors.lastname: Poonsab
authors.affiliation: Department of Surgery, Rajavithi Hospital, Bangkok, Thailand.
authors.forename: Thawee
authors.initials: T
authors.lastname: Ratanachu-Ek
authors.affiliation: Division of Gastroenterology, Rajavithi Hospital, Bangkok, Thailand.
authors.forename: Piyathida
authors.initials: P
authors.lastname: Hansomburana
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Bangkok, Thailand.
authors.forename: Bubpha
authors.initials: B
authors.lastname: Pornthisarn
authors.affiliation: Division of Gastroenterology, Bangkok Metropolitan Administration General Hospital, Bangkok, Thailand.
authors.forename: Thirada
authors.initials: T
authors.lastname: Thongbai
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Varocha
authors.initials: V
authors.lastname: Mahachai
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Sombat
authors.initials: S
authors.lastname: Treeprasertsuk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000453:epidemiology*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D014859:Warfarin