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168 REAL-LIFE PRACTICES IN THE MANAGEMENT OF PEPTIC ULCER BLEEDING IN PATIENTS WITH MYOCARDIAL INFARCTIONS J Cheung, M Stamm, D Moroz, J Rajala, G Sandha AIM: Patients with myocardial infarctions (MI) are at risk of peptic ulcer disease (PUD) bleeding given the routine use of anti-platelet agents and anticoagulants. Real-life practices in the management of PUD bleeding in patients with myocardial infarctions have not been documented.
University of Alberta, Edmonton, Alberta
METHODS: Patients who experienced both a myocardial infarction and PUD bleeding in the same hospital between January 2003 - January 2006 were evaluated. Coronary care practices, PUD bleeding practices, and patient outcomes were determined.
RESULTS: Hospital charts for 25 patients were reviewed retrospectively. Many patients were already on ASA (n = 18, 69%) or NSAIDS (n = 6, 23%) prior to hospitalization. Many patients received ASA (n = 23, 89%), clopidogrel (n = 13, 50%), and heparin (n = 23, 89%) during an MI. Only 4 (16%) patients were on a proton pump inhibitor prior to hospitalization. A high proportion of PUD bleeding was due to high-risk lesions (44%) requiring endoscopic therapy. Once PUD bleeding was diagnosed, 32% continued on ASA therapy without interruption, 48% had ASA therapy held temporarily, and 20% were not restarted on ASA therapy. In the group where ASA was continued after PUD bleeding, there was no difference in the PUD rebleeding rate when compared to patients where ASA has held (13% vs 17%, respectively). There was no difference in the recurrent MI and mortality rate. There was also no difference in the baseline characteristics (age, Rockall score, Killip score, ST elevation MI, high risk ulcers).
CONCLUSION: A large proportion of patients with MI who develop PUD bleeding are on ASA or NSAIDs prior to hospitalization. A high proportion of patients with PUD bleeding diagnosed peri-MI have high risk stigmata that require endoscopic therapy. Immediate continuation of ASA does not appear to increase PUD rebleeding rates when given with concurrent acid suppressive therapy.