Periprocedural and long-term gastrointestinal bleeding in patients undergoing percutaneous coronary intervention
- David R Holmes, Jr, MD
David R Holmes, Jr, MD
- Professor of Medicine
- Mayo Clinic College of Medicine
- Paul Sorajja, MD
Paul Sorajja, MD
- Director, Center for Valve and Structural Heart Disease
- Minneapolis Heart Institute
- Section Editors
- Donald Cutlip, MD
Donald Cutlip, MD
- Section Editor — Interventional Cardiology
- Professor of Medicine
- Harvard Medical School
- Beth Israel Deaconess Medical Center
- John R Saltzman, MD, FACP, FACG, FASGE, AGAF
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
- Section Editor — Therapeutic and Diagnostic Endoscopy
- Professor of Medicine
- Harvard Medical School
Periprocedural and long-term antithrombotic (anticoagulant or antiplatelet) therapy is an integral part of percutaneous coronary intervention (with either coronary artery stenting or percutaneous transluminal coronary angioplasty). Antithrombotic therapy has been shown to prevent periprocedural and long-term cardiovascular events such as stent thrombosis and recurrent myocardial infarction. (See "Long-term antiplatelet therapy after coronary artery stenting in stable patients" and "Antithrombotic therapy for elective percutaneous coronary intervention: General use".)
Current antithrombotic regimens have the potential to result in either new gastrointestinal (GI) bleeding or to exacerbate chronic episodic GI bleeding. For those with GI bleeding, there is significant attributable morbidity and mortality. However, in many such patients, alternatives to percutaneous coronary intervention (PCI) may be limited. Given the fact that over one million PCI procedures are performed annually, and that antithrombotic therapy has become more aggressive, there is a need to understand the unique challenges in the prevention and management of GI bleeding in this patient population. Furthermore, with the increasing adoption of a radial as compared to femoral artery approach, GI bleeding may be the most common type of bleeding associated with PCI.
This topic focuses on periprocedural and long-term GI bleeding in patients undergoing PCI. Issues of GI bleeding in patients on chronic anticoagulant or nonsteroidal antiinflammatory therapy are discussed elsewhere. (See "Antithrombotic therapy after coronary stenting in patients receiving long-term anticoagulation" and "NSAIDs (including aspirin): Primary prevention of gastroduodenal toxicity".)
Periprocedural bleeding not related to the GI tract in patients undergoing PCI is discussed separately. (See "Periprocedural bleeding in patients undergoing percutaneous coronary intervention".)
While strict definitions of peri-procedural bleeding in percutaneous coronary intervention (PCI) patients have been adopted, there is less consensus on what constitutes clinically significant gastrointestinal (GI) bleeding. (See "Periprocedural bleeding in patients undergoing percutaneous coronary intervention".)
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