Upper gastrointestinal haemorrhage in the acute cardiac care setting: antiplatelets and endoscopy

• Published in: Scottish medical journal 2012-05, Vol.57 (2), p.88-91
• Main Authors: Musa, S A, Brecker, S J, Rahman, T M, Kang, J Y
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Drug Administration Schedule; Duodenal Ulcer - complications; Duodenal Ulcer - mortality; Endoscopy, Gastrointestinal; Epinephrine - administration & dosage; Female; Follow-Up Studies; Gastrointestinal Hemorrhage - chemically induced; Gastrointestinal Hemorrhage - drug therapy; Gastrointestinal Hemorrhage - mortality; Heart Diseases - drug therapy; Heart Diseases - mortality; Humans; Male; Melena - chemically induced; Middle Aged; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Prospective Studies; Recurrence; Risk Factors; Time Factors; Upper Gastrointestinal Tract - drug effects; Vasoconstrictor Agents - administration & dosage
• ISSN: 0036-9330; 2045-6441
• DOI: 10.1258/smj.2012.012006

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.