EFFECT OF COMBINED ANTICOAGULATION AND LOW-DOSE ASPIRIN TREATMENT ON UPPER GASTROINTESTINAL-BLEEDING

Multiple studies link the use of nonsteroidal antiinflammatory drugs ( NSAIDs) with severe upper gastrointestinal bleeding (UGIB); the incide nce of such bleeding is 2-4%. One common regimen to assure patency aft er intracoronary stent placement requires an anticoagulant (warfarin) combined with aspirin as an antiplatelet agent. However, a 13-fold inc rease in the risk of UGIB occurs with long-term use of oral anticoagul ants and NSAIDs. We retrospectively assessed the rate of UGIB in 138 p atients who had received coronary stents (group I, receiving heparin f ollowed by warfarin in combination with aspirin) and 109 angioplasty p atients without stents (group II, receiving aspirin alone) between 199 0 and 1994. UGIB was identified by hematemesis or melena, which led to gastrointestinal consultation. Patients were analyzed for multiple ri sk factors. UGIB occurred in 28 of 138 group I patients (20%; 95% CI 1 3.3-26.7%) and 0 of 109 group II patients (P < 0.0001). Esophagogastro duodenoscopy (EGD) findings on the 28 patients with UGIB included 13 p atients with esophagitis or gastritis, 7 patients with gastric or duod enal ulcers, and 8 patients with no identifiable source of bleeding. U GIB occurred within a mean of 2.5 days of initiation of combination th erapy. Of patients with UGIB, 10 required blood transfusion (mean numb er of units = 5.3). Previous history of peptic ulcer disease, smoking, and use of antiulcer medication did not significantly differ between the two groups. The concurrent use of anticoagulant and aspirin in pat ients with coronary stents creates a significant potential for UGIB an d should be used only with extreme caution.