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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
2012 Impact Factor: 7.553
2012 SCImago Journal Rankings: 2.574
 
DOIhttp://dx.doi.org/10.1111/j.1572-0241.2007.01715.x
 
ISI Accession Number IDWOS:000254665200009
 
ReferencesReferences in Scopus
 
DC FieldValue
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
 
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dc.identifier.issn0002-9270
2012 Impact Factor: 7.553
2012 SCImago Journal Rankings: 2.574
 
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
 
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Author Affiliations
  1. The University of Hong Kong
  2. Ruttonjee Hospital Hong Kong