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Article: Gastrointestinal bleeding in patients receiving a combination of aspirin, clopidogrel, and enoxaparin in acute coronary syndrome

TitleGastrointestinal bleeding in patients receiving a combination of aspirin, clopidogrel, and enoxaparin in acute coronary syndrome
Authors
Issue Date2008
PublisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/ajg/index.html
Citation
American Journal Of Gastroenterology, 2008, v. 103 n. 4, p. 865-871 How to Cite?
AbstractBACKGROUND: The combination of aspirin, clopidogrel, and enoxaparin (combination therapy) is the standard treatment for acute coronary syndrome but is associated with gastrointestinal bleeding. However, information in this area is scarce. AIM: This retrospective study aimed to determine the incidence of upper gastrointestinal bleeding in a real-life situation. The effect of proton pump inhibitor (PPI) treatment was also analyzed. METHOD: From January 2002 to December 2006, all patients receiving combination therapy were analyzed. The end point was the occurrence of upper gastrointestinal bleeding during combination therapy or within 7 days of stopping enoxaparin. RESULTS: The patient group consisted of 666 patients (age 72.1 ± 12.6 yr). Gastrointestinal bleeding occurred in 18 (2.7%) patients. The overall hospital mortality was 4.1% (27 patients). A cardiac event was the major cause (N = 24, 3.6%). Only one patient died of massive gastrointestinal bleeding (0.15%). Multiple logistic regression analysis demonstrated that previous peptic ulcer, cardiogenic shock, and the lack of PPI coprescription were significant risk factors for gastrointestinal bleeding. The age-adjusted odds ratio (95% confidence interval) for gastrointestinal bleeding was 5.07 (1.31-16.58) for previous peptic ulcer, 21.41 (2.56-146.68) for cardiogenic shock, and 0.068 (0.010-0.272) for the coprescription with a PPI. CONCLUSION: In real life, the incidence of gastrointestinal bleeding associated with the combination of aspirin, clopidogrel, and enoxaparin therapy was estimated to be 2.7%. Previous peptic ulcer disease or cardiogenic shock were significant independent risk factors. Coprescription with a PPI can significantly reduce the risk. © 2008 by Am. Coll. of Gastroenterology.
Persistent Identifierhttp://hdl.handle.net/10722/163158
ISSN
2014 Impact Factor: 10.755
2014 SCImago Journal Rankings: 3.376
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorNg, FHen_US
dc.contributor.authorWong, SYen_US
dc.contributor.authorLam, KFen_US
dc.contributor.authorChang, CMen_US
dc.contributor.authorLau, YKen_US
dc.contributor.authorChu, WMen_US
dc.contributor.authorWong, BCYen_US
dc.date.accessioned2012-09-05T05:28:16Z-
dc.date.available2012-09-05T05:28:16Z-
dc.date.issued2008en_US
dc.identifier.citationAmerican Journal Of Gastroenterology, 2008, v. 103 n. 4, p. 865-871en_US
dc.identifier.issn0002-9270en_US
dc.identifier.urihttp://hdl.handle.net/10722/163158-
dc.description.abstractBACKGROUND: The combination of aspirin, clopidogrel, and enoxaparin (combination therapy) is the standard treatment for acute coronary syndrome but is associated with gastrointestinal bleeding. However, information in this area is scarce. AIM: This retrospective study aimed to determine the incidence of upper gastrointestinal bleeding in a real-life situation. The effect of proton pump inhibitor (PPI) treatment was also analyzed. METHOD: From January 2002 to December 2006, all patients receiving combination therapy were analyzed. The end point was the occurrence of upper gastrointestinal bleeding during combination therapy or within 7 days of stopping enoxaparin. RESULTS: The patient group consisted of 666 patients (age 72.1 ± 12.6 yr). Gastrointestinal bleeding occurred in 18 (2.7%) patients. The overall hospital mortality was 4.1% (27 patients). A cardiac event was the major cause (N = 24, 3.6%). Only one patient died of massive gastrointestinal bleeding (0.15%). Multiple logistic regression analysis demonstrated that previous peptic ulcer, cardiogenic shock, and the lack of PPI coprescription were significant risk factors for gastrointestinal bleeding. The age-adjusted odds ratio (95% confidence interval) for gastrointestinal bleeding was 5.07 (1.31-16.58) for previous peptic ulcer, 21.41 (2.56-146.68) for cardiogenic shock, and 0.068 (0.010-0.272) for the coprescription with a PPI. CONCLUSION: In real life, the incidence of gastrointestinal bleeding associated with the combination of aspirin, clopidogrel, and enoxaparin therapy was estimated to be 2.7%. Previous peptic ulcer disease or cardiogenic shock were significant independent risk factors. Coprescription with a PPI can significantly reduce the risk. © 2008 by Am. Coll. of Gastroenterology.en_US
dc.languageengen_US
dc.publisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/ajg/index.htmlen_US
dc.relation.ispartofAmerican Journal of Gastroenterologyen_US
dc.subject.meshAcute Coronary Syndrome - Drug Therapyen_US
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshAged, 80 And Overen_US
dc.subject.meshAnticoagulants - Adverse Effectsen_US
dc.subject.meshAspirin - Adverse Effectsen_US
dc.subject.meshDrug Therapy, Combinationen_US
dc.subject.meshEnoxaparin - Adverse Effectsen_US
dc.subject.meshFemaleen_US
dc.subject.meshGastrointestinal Hemorrhage - Chemically Induceden_US
dc.subject.meshHumansen_US
dc.subject.meshLogistic Modelsen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshPlatelet Aggregation Inhibitors - Adverse Effectsen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshStatistics, Nonparametricen_US
dc.subject.meshTiclopidine - Adverse Effects - Analogs & Derivativesen_US
dc.titleGastrointestinal bleeding in patients receiving a combination of aspirin, clopidogrel, and enoxaparin in acute coronary syndromeen_US
dc.typeArticleen_US
dc.identifier.emailLam, KF:hrntlkf@hkucc.hku.hken_US
dc.identifier.emailWong, BCY:bcywong@hku.hken_US
dc.identifier.authorityLam, KF=rp00718en_US
dc.identifier.authorityWong, BCY=rp00429en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1111/j.1572-0241.2007.01715.xen_US
dc.identifier.pmid18177451en_US
dc.identifier.scopuseid_2-s2.0-41849094074en_US
dc.identifier.hkuros147577-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-41849094074&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume103en_US
dc.identifier.issue4en_US
dc.identifier.spage865en_US
dc.identifier.epage871en_US
dc.identifier.isiWOS:000254665200009-
dc.publisher.placeUnited Statesen_US
dc.identifier.f10001108609-
dc.identifier.scopusauthoridNg, FH=16936078000en_US
dc.identifier.scopusauthoridWong, SY=7404590845en_US
dc.identifier.scopusauthoridLam, KF=8948421200en_US
dc.identifier.scopusauthoridChang, CM=20833817800en_US
dc.identifier.scopusauthoridLau, YK=7201403303en_US
dc.identifier.scopusauthoridChu, WM=23995209500en_US
dc.identifier.scopusauthoridWong, BCY=7402023340en_US
dc.identifier.citeulike2640574-

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