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| |  Aspirin Use in the Setting of Acute Myocardial Infarction and Peptic Ulcer Bleeding Does Not Increase the Rebleeding Rate: Presented at ACG By Danny Kucharsky PHILADELPHIA, PA -- October 25, 2007 -- Continuation of aspirin (ASA) prophylaxis in patients who have peptic ulcer disease (PUD) bleeding during acute myocardial infarction (MI) does not appear to increase rebleeding rates or transfusion need when given with concurrent PUD therapy, according to a study presented here at the annual scientific meeting of the American College of Gastroenterology (ACT). The study aimed to determine the clinical practices and outcomes of patients who have both of a peptic ulcer bleeding and an acute MI. It was presented by Justin Cheung, MD, Research Fellow, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada. In his presentation, Dr. Cheung said patients with PUD who have an acute MI are at risk of bleeding complications given the routine use of antiplatelet agents and anticoagulants. Practices in the management of PUD bleeding in patients with MI have not been documented. "There is no standardised strategy in the antiplatelet management of patients with an acute MI who also have peptic ulcer bleeding," Dr. Cheung said. Therefore, his research team conducted a chart review of medical records for 710 patients with gastrointestinal bleeding and myocardial infarction history between 1990 and 2006 at two tertiary care centres. Of these, 102 patients experienced both an acute (MI) and PUD bleeding in the same hospitalisation. Patterns of ASA use and use of nonsteroidal anti-inflammatory drugs (NSAIDs) were determined and peptic ulcer rebleeding rates and cardiac outcomes were assessed. PUD patients were divided into two groups based on ASA use: ASA continuous post-PUD bleeding and ASA withheld at least temporarily post-PUD bleeding. Results found that many patients were on ASA (55%) and NSAIDs (27%) prior to hospitalisation, while 12% were on proton pump inhibitors. ASA was never restarted in 37% of patients with AMI and PUD bleeding, while ASA was more likely to be continued during PUD bleeding in patients with angioplasty, stents, coronary artery bypass graft surgery and ST segment elevation MI (P <.05). There was no difference in rates of rebleeding due to ulcers with low-risk stigmata between patients who continued ASA therapy compared with those who had ASA withheld or discontinued (4.0% vs 7.5%). Among patients with high-risk stigmata, there was no difference in the rate of rebleeding rate between patients who continued ASA therapy compared with those who had ASA withheld or discontinued (23% vs 29%). When ASA was continued, there was no increase in the rebleeding rate when clopidogrel was used or not (7% vs 11%). Mortality tended to be lower in patients who had ASA continued compared with those who had ASA withheld or discontinued (9% vs 16%). The study concluded that many patients with MI who develop bleeding due to PUD are on ASA or NSAIDs prior to hospitalisation. Few, however are on proton pump inhibitors. In addition, Dr. Cheung said one third of patients are not biopsied for Helicobacter pylori infection and more than two thirds have ASA withheld or never restarted after an acute MI. Larger studies are needed to confirm these findings, Dr. Cheung said.
[Presentation title: Aspirin Use in the Setting of Acute Myocardial Infarction and Peptic Ulcer Bleeding Does Not Increase the Rebleeding Rate. Abstract 31]
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