Upper Gastrointestinal Bleeding in Patients Receiving Dual Antiplatelet Therapy after Coronary Stenting
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概要
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Objective We investigated the risk of upper gastrointestinal (UGI) bleeding and the protective effect of concomitant anti-secretory drugs during dual antiplatelet therapy administered following implantation of drug-eluting stents (DES) for coronary heart disease. Because proton pump inhibitors (PPIs) are reported to decrease the platelet inhibitory effects of clopidogrel, we also assessed cardiovascular outcomes in patients taking thienopyridine derivatives with or without anti-secretory drug. Methods We retrospectively analyzed 243 patients, who underwent DES implantation between January 2006 and December 2007 and were receiving dual anti-platelet therapy post-surgery. The main outcome measurement was the presence of UGI bleeding. Cardiovascular outcomes were assessed by follow-up coronary angiography (CAG) findings. Data were collected from medical records. Results Eight cases of UGI bleeding were observed during the follow-up period, none of whom were taking anti-secretory drugs. Among the 243 cases, 108 cases were taking anti-secretory drugs: a PPI (67 cases), and an H2 receptor antagonist (41 cases). No UGI bleeding was observed among patients who were taking concomitant anti-secretory drugs. The 1- and 2-year cumulative incidences of UGI bleeding among patients who were not taking anti-secretory drugs were 4.5% and 9.2%, respectively. When CAG findings were compared between patients not taking any anti-secretory drug, taking PPI, or taking H2RA, significantly more stenotic lesions of the coronary artery were observed in the PPI-treatment group. Conclusion Concomitant use of an anti-secretory agent was associated with a reduced risk of UGI bleeding. Use of PPI may be associated with an attenuation of the effect of dual antiplatelet therapy.
著者
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TAKEYAMA Youichi
Division of Cardiology, Showa University Fujigaoka Hospital
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Takeyama Youichi
Division Of Cardiology Department Of Internal Medicine Showa University Fujigaoka Hospital
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Inoue Kazuaki
Division Of Gastroenterology Showa University Fujigaoka Hospital
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ENDO Yutaka
Division of Gastroenterology, Showa University Fujigaoka Hospital
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Asano Fuyuki
Division of Cardiology, Showa University Fujigaoka Hospital
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Yamada Masaya
Division Of Gastroenterology Showa University Fujigaoka Hospital
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Yoshiba Makoto
Division Of Gastroenterology Showa University Fujigaoka Hospital
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Yasuda Hiroshi
Division Of Gastroenterology Showa University Fujigaoka Hospital
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Sawada Susumu
Division of Gastroenterology, Showa University Fujigaoka Hospital
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