Dual antiplatelet therapy in GI-bleed patients with extensive coronary artery disease history: a systematic review.

Abstract

Introduction: Extensive coronary artery disease whether at initial presentation or after percutaneous coronary intervention (PCI), involves the use of dual antiplatelet therapy (DAPT) as a very significant therapeutic option. There are many reasons why clinicians should weigh the risks of bleeding and cardiovascular thrombosis when deciding whether to maintain or discontinue DAPT in such patients.

Methods: This comprehensive review systematically analyzed via electronic databases, a total of 39 papers most of which were on countries in Southeast Asia. The focus was on randomized control designs (RCTs) and observational studies.

Results and discussion: PCI with drug eluting stents was the most common method of treating acute coronary syndrome. The study found more independent predictors of gastrointestinal (GI) bleeding in young and elderly patients from Southeast Asia. The precise DAPT score was more readily used among various bleeding risk prediction models for patients on antiplatelet therapy.

Conclusion: The use of DAPT in the setting of the GI bleeding risk in patients with coronary artery disease has been studied extensively, but there are still no clearly defined strategies and very definite answers to the risk of bleeding versus cardiac event envisaged during the management of an extensive acute coronary disease mostly in southeast Asia. More studies using good study designs and statistics and establishing clinical prediction rules, are needed to fill this knowledge gap most especially in Southeast Asia and Middle East.