Risk Factors for Upper Gastrointestinal Bleeding in Patients Undergoing Percutaneous Coronary Intervention on Dual Antiplatelet Therapy with Assessment of Anti-Ulcer Medication Effects.

IF 1.8 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Chun-Ting Shih, Ting-Hsin Huang, Chih-Ming Liang, You-Cheng Zheng, Yi-Lin Chen, Han-Tan Chai, Po-Jui Wu, Chien-Jen Chen, Huang-Chung Chen, Shaur-Zheng Chong
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Abstract

Background: Patients in the coronary care unit (CCU) who undergo percutaneous coronary intervention (PCI) and receive dual antiplatelet treatment (DAPT) are at an increased risk of upper gastrointestinal bleeding (UGIB). The effectiveness of histamine-2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs) in preventing UGIB in this context remains uncertain.

Methods: This retrospective study enrolled 288 CCU patients undergoing DAPT after PCI, and the incidence of UGIB was assessed at specific timeframes: within 72 hours and beyond 72 hours post catheterization. Factors considered included patient histories, medication regimens (PPIs, H2RAs), and the absence of prophylactic UGIB medication.

Results: Within 72 hours, acute UGIB occurred in 8.3% of the patients, with a history of cerebrovascular accident and higher Killip grade identified as risk factors. Excluding the acute cases, the other patients received PPIs (n = 41), H2RAs (n = 57), or no prophylactic medication (n = 166). Delayed UGIB (> 72 hours) occurred in 4.9% of the patients, with chronic kidney disease and higher Killip grade identified as significant risk factors. UGIB rates in the PPI, H2RA, and non-prophylactic groups showed no significant difference (p = 0.264), and TriMatch analysis revealed consistent rates (7.5%, 7.5%, 5.0%) (p = 0.875).

Conclusions: No significant difference was found in the incidence of UGIB post PCI between the patients who did and did not receive prophylactic anti-ulcer medications. However, prophylactic medication and vigilant monitoring are suggested for high-risk UGIB patients within the critical CCU setting.

双重抗血小板治疗经皮冠状动脉介入治疗患者上消化道出血的危险因素及抗溃疡药物疗效评价
背景:在冠心病监护室(CCU)接受经皮冠状动脉介入治疗(PCI)和双重抗血小板治疗(DAPT)的患者发生上消化道出血(UGIB)的风险增加。在这种情况下,组胺-2受体拮抗剂(H2RAs)或质子泵抑制剂(PPIs)在预防UGIB方面的有效性仍不确定。方法:本回顾性研究纳入288例PCI术后行DAPT的CCU患者,在特定时间段(置管后72小时内和72小时后)评估UGIB的发生率。考虑的因素包括患者病史、用药方案(ppi、H2RAs)和缺乏预防性UGIB药物。结果:72小时内发生急性UGIB的患者占8.3%,有脑血管意外史和较高的Killip分级为危险因素。除急性病例外,其余患者均接受PPIs治疗(n = 41)、H2RAs治疗(n = 57)或未使用预防性药物治疗(n = 166)。迟发性UGIB (bb0 72小时)发生在4.9%的患者中,慢性肾脏疾病和较高的Killip分级被认为是重要的危险因素。PPI组、H2RA组和非预防组的UGIB发生率无显著差异(p = 0.264), trimmatch分析显示两者发生率一致(7.5%、7.5%、5.0%)(p = 0.875)。结论:接受和未接受预防性抗溃疡药物治疗的患者PCI术后UGIB发生率无显著差异。然而,对于危重CCU环境中的高危UGIB患者,建议预防性用药和警惕监测。
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来源期刊
Acta Cardiologica Sinica
Acta Cardiologica Sinica 医学-心血管系统
CiteScore
2.90
自引率
15.80%
发文量
144
审稿时长
>12 weeks
期刊介绍: Acta Cardiologica Sinica welcomes all the papers in the fields related to cardiovascular medicine including basic research, vascular biology, clinical pharmacology, clinical trial, critical care medicine, coronary artery disease, interventional cardiology, arrythmia and electrophysiology, atherosclerosis, hypertension, cardiomyopathy and heart failure, valvular and structure cardiac disease, pediatric cardiology, cardiovascular surgery, and so on. We received papers from more than 20 countries and areas of the world. Currently, 40% of the papers were submitted to Acta Cardiologica Sinica from Taiwan, 20% from China, and 20% from the other countries and areas in the world. The acceptance rate for publication was around 50% in general.
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