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Predictors and outcomes associated with gastrointestinal bleeding in patients with acute coronary syndromes

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Abstract

Background

Potent antiplatelet and anticoagulant agents along with early revascularization are increasingly used in patients hospitalized with acute coronary syndromes (ACS). An important complication associated with these therapies is gastrointestinal bleeding (GIB); yet, the predictors, optimal management, and outcomes associated with GIB in ACS patients are poorly studied.

Methods

We investigated the incidence, predictors, pathological findings, and clinical outcomes associated with GIB in patients with ACS hospitalized at a United States tertiary center between 1996 and 2001.

Results

Three percent (80/3,045) of ACS patients developed clinically significant GIB. Predictors of GIB were older age, female gender, non-smoking status, peak troponin I, and prior heart failure, diabetes, or hypertension. Patients with GIB were more critically ill with lower blood pressure and higher heart rates. GIB was associated with an increased need for transfusion, mechanical ventilation, and inotropes/pressors. In-hospital mortality was significantly higher in ACS patients with versus without GIB (36% vs. 5%, P < 0.001). Thirty patients (38%) with GIB underwent endoscopy with no procedural complications of death, arrhythmia, urgent ischemia, or hemodynamic deterioration.

Conclusion

In patients with ACS, GIB is associated with older age, female sex, peak troponin I, non-smoking status, diabetes, hypertension, and heart failure. Hospital mortality is increased eightfold when ACS patients experience GIB. More studies are needed to establish the safety of and optimal timing of endoscopy in these patients.

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Authors and Affiliations

  1. Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA

    Mouaz Al-Mallah, Rasha N. Bazari, Michelle Jankowski & Michael P. Hudson

  2. Department of Biostatistics and Research Epidemiology, Henry Ford Hospital, Detroit, MI, USA

    Mouaz Al-Mallah, Rasha N. Bazari, Michelle Jankowski & Michael P. Hudson

  3. Henry Ford Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI, USA

    Mouaz Al-Mallah, Rasha N. Bazari, Michelle Jankowski & Michael P. Hudson

  4. Division of Cardiovascular Medicine, Henry Ford Hospital (K-14), 2799 West Grand Blvd., Detroit, MI, 48202, USA

    Mouaz Al-Mallah

Authors
  1. Mouaz Al-Mallah
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  2. Rasha N. Bazari
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  3. Michelle Jankowski
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  4. Michael P. Hudson
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Correspondence to Mouaz Al-Mallah.

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Al-Mallah, M., Bazari, R.N., Jankowski, M. et al. Predictors and outcomes associated with gastrointestinal bleeding in patients with acute coronary syndromes. J Thromb Thrombolysis 23, 51–55 (2007). https://doi.org/10.1007/s11239-006-9005-8

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  • DOI: https://doi.org/10.1007/s11239-006-9005-8

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