Bleeding from the upper gastrointestinal tract in patients with acute coronary pathology receiving dual antiplatelet therapy

Funding Acknowledgements

Type of funding sources: None. Main funding source(s): own funds

Routine administration of dual antiplatelet therapy reduces the incidence of thrombotic complications and deaths in patients with acute coronary syndrome. However, the widespread use of antithrombotic therapy in these patients is associated with a significant risk of bleeding from the upper gastrointestinal tract. Their frequency in patients with AMI according to various data ranges from 1.1% to 2.3%.

Purpose of the study. To determine the risk factors for upper gastrointestinal bleeding and its outcome in patients with acute coronary pathology receiving dual antiplatelet therapy.

Methods. Analyzed 2632 patients with acute myocardial infarction and 2114 patients with unstable angina who were admitted for a 10-year period (2011-2020) and underwent emergency coronary angiography. The average age of patients is 57 ± 9 years, women – 1649 (35%), men – 3097 (65%).

All patients received dual antiplatelet therapy (acetylsalicylic acid and P2Y12 inhibitor). Studies of the state of the gastric mucosa and duodenum were carried out by endoscopic method, which revealed 31 cases of bleeding. Various baseline characteristics and risk factors for upper gastrointestinal bleeding were evaluated.

Results. The source of bleeding was: gastric ulcer - 8 cases (26%), duodenal ulcer - 6 (20%), simultaneously 2 or more ulcers - 4 (14%), multiple acute erosions - 8 (26%), single acute erosions of the antral part of the stomach - 2 (7%), Mallory-Weiss syndrome - 2 (7%) and bleeding from varicose veins of the esophagus - 1 (3%). Clinically, patients noted pronounced weakness, dizziness, coffee ground vomitus was observed in 8 (26%) patients, melena in 14 (45 %) patients. Bleeding from the upper gastrointestinal tract was detected in 20 patients with AMI (1% of all AMI) and is characterized by a high frequency of deaths (9; 45%). Fatal cases are mainly associated with the appearance of several ulcers of different localization (multiple acute erosions of the stomach and duodenum). In patients with unstable angina, the frequency of bleeding from the upper GIT is about 0.5%, while the duration of hospitalization is extended by an average of 8 days.

Predictors of bleeding from the GIT in patients with acute coronary pathology include

the presence of peptic ulcer disease in the anamnesis, elderly (senile) age, previous long-term use of antiplatelet agents (anticoagulants).

Conclusion

Bleedings from the upper GIT are a serious clinical problem in patients with acute coronary pathology. They are characterized by a long stay in the hospital and a high mortality rate.