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

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TitleGastrointestinal bleeding in patients receiving a combination of aspirin, clopidogrel, and enoxaparin in acute coronary syndrome
AuthorsNg, FH2
Wong, SY2
Lam, KF1
Chang, CM2
Lau, YK2
Chu, WM2
Wong, BCY1
Issue Date2008
PublisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/ajg/index.html
CitationAmerican Journal Of Gastroenterology, 2008, v. 103 n. 4, p. 865-871 [How to Cite?]
DOI: http://dx.doi.org/10.1111/j.1572-0241.2007.01715.x
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.
ISSN0002-9270
2011 Impact Factor: 7.282
2011 SCImago Journal Rankings: 0.573
DOIhttp://dx.doi.org/10.1111/j.1572-0241.2007.01715.x
ISI Accession Number IDWOS:000254665200009
ReferencesReferences in Scopus
DC Field
Value
dc.contributor.authorNg, FH
dc.contributor.authorWong, SY
dc.contributor.authorLam, KF
dc.contributor.authorChang, CM
dc.contributor.authorLau, YK
dc.contributor.authorChu, WM
dc.contributor.authorWong, BCY
dc.date.accessioned2012-09-05T05:28:16Z
dc.date.available2012-09-05T05:28:16Z
dc.date.issued2008
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.
dc.description.natureLink_to_subscribed_fulltext
dc.identifier.citationAmerican Journal Of Gastroenterology, 2008, v. 103 n. 4, p. 865-871 [How to Cite?]
DOI: http://dx.doi.org/10.1111/j.1572-0241.2007.01715.x
dc.identifier.citeulike2640574
dc.identifier.doihttp://dx.doi.org/10.1111/j.1572-0241.2007.01715.x
dc.identifier.epage871
dc.identifier.hkuros147577
dc.identifier.isiWOS:000254665200009
dc.identifier.issn0002-9270
2011 Impact Factor: 7.282
2011 SCImago Journal Rankings: 0.573
dc.identifier.issue4
dc.identifier.pmid18177451
dc.identifier.scopuseid_2-s2.0-41849094074
dc.identifier.spage865
dc.identifier.urihttp://hdl.handle.net/10722/163158
dc.identifier.volume103
dc.languageeng
dc.publisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/ajg/index.html
dc.publisher.placeUnited States
dc.relation.ispartofAmerican Journal of Gastroenterology
dc.relation.referencesReferences in Scopus
dc.subject.meshAcute Coronary Syndrome - Drug Therapy
dc.subject.meshAdult
dc.subject.meshAged
dc.subject.meshAged, 80 And Over
dc.subject.meshAnticoagulants - Adverse Effects
dc.subject.meshAspirin - Adverse Effects
dc.subject.meshDrug Therapy, Combination
dc.subject.meshEnoxaparin - Adverse Effects
dc.subject.meshFemale
dc.subject.meshGastrointestinal Hemorrhage - Chemically Induced
dc.subject.meshHumans
dc.subject.meshLogistic Models
dc.subject.meshMale
dc.subject.meshMiddle Aged
dc.subject.meshPlatelet Aggregation Inhibitors - Adverse Effects
dc.subject.meshRetrospective Studies
dc.subject.meshStatistics, Nonparametric
dc.subject.meshTiclopidine - Adverse Effects - Analogs & Derivatives
dc.titleGastrointestinal bleeding in patients receiving a combination of aspirin, clopidogrel, and enoxaparin in acute coronary syndrome
dc.typeArticle
Author Affiliations
  1. The University of Hong Kong
  2. Ruttonjee Hospital Hong Kong