Abstract
Multiple studies link the use of nonsteroidalantiinflammatory drugs (NSAIDs) with severe uppergastrointestinal bleeding (UGIB); the incidence of suchbleeding is 2-4%. One common regimen to assure patency after intracoronary stent placement requires ananticoagulant (warfarin) combined with aspirin as anantiplatelet agent. However, a 13-fold increase in therisk of UGIB occurs with long-term use of oral anticoagulants and NSAIDs. We retrospectivelyassessed the rate of UGIB in 138 patients who hadreceived coronary stents (group I, receiving heparinfollowed by warfarin in combination with aspirin) and 109 angioplasty patients without stents (groupII, receiving aspirin alone) between 1990 and 1994. UGIBwas identified by hematemesis or melena, which led togastrointestinal consultation. Patients were analyzed for multiple risk factors. UGIBoccurred in 28 of 138 group I patients (20%; 95% CI13.3-26.7%) and 0 of 109 group II patients (P ≤0.0001). Esophagogastroduodenoscopy (EGD) findings onthe 28 patients with UGIB included 13 patients with esophagitisor gastritis, 7 patients with gastric or duodenalulcers, and 8 patients with no identifiable source ofbleeding. UGIB occurred within a mean of 2.5 days of initiation of combination therapy. Ofpatients with UGIB, 10 required blood transfusion (meannumber of units 5.3). Previous history of peptic ulcerdisease, smoking, and use of antiulcer medication did not significantly differ between the twogroups. The concurrent use of anticoagulant and aspirinin patients with coronary stents creates a significantpotential for UGIB and should be used only with extreme caution.
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Younossi, Z.M., Strum, W.B., Schatz, R.A. et al. Effect of Combined Anticoagulation and Low-Dose Aspirin Treatment on Upper Gastrointestinal Bleeding. Dig Dis Sci 42, 79–82 (1997). https://doi.org/10.1023/A:1018833021039
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DOI: https://doi.org/10.1023/A:1018833021039