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A Lazarescu, J Martin, J Gregor

Department of Medicine, University of Western Ontario, London, Ontario

BACKGROUND: Aggressive thrombosis prevention is commonly practiced after percutaneous coronary interventions (PCI). There is little data on the risk of gastrointestinal (GI) bleeding associated with the use of platelet glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors.

METHODS: Retrospective cohort study of 782 consecutive patients undergoing PCI who received a GP IIb/IIIa inhibitor, either eptifibatide (Integrilin) or abciximab (ReoPro).

RESULTS: Seven cases (0.90%) of significant GI bleeding were identified. The patients ranged in age from 47-77 years, mean 63.7 years. There were 5 males and 2 females. Four patients received ReoPro and 3 patients received Integrilin. All patients were also receiving aspirin and clopidogrel post-PCI. In 5 patients, the cause of the GI bleed was in the upper tract, including Mallory-Weiss tear, nasogastric tube trauma, gastric ulcer, gastritis with gastric erosions, and duodenal ulcer. None of the upper GI lesions had high risk stigmata. In 2 patients, the cause of the GI bleed was in the lower tract, one from a circumferential ulcerated tumour in the sigmoid, the other from an ulcerated lesion with a non-bleeding visible vessel at the anorectal junction. None of the patients required therapeutic endoscopy. Three of the patients required blood transfusions as part of the management of their GI bleed.

CONCLUSIONS: GP IIb/IIa inhibitors used during PCI appear to be associated with a low risk of GI bleeding. When GI bleeding occurs, it is usually from a preexisting lesion and does not require endoscopic or surgical intervention. Blood transfusion is necessary less than half the time.

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