Clinical Characteristics of Patients Hospitalized Again with Gastrointestinal Bleeding and Receiving Dual Antiplatelet Treatment after PCI

Objective To explore clinical characteristics in patients suffering gastrointestinal bleeding and receiving double anti-platelet therapy （DAPT） after percutaneous coronary intervention. Methods We have screened 2 675 patients hospitalized again receiving dual antiplatelet treatment after percutaneous coronary intervention at Guangdong General Hospital, between 2011 and 2013. Overall, the data from 28 patients with suspected gastrointestinal bleeding were collected. And 21 patients were diagnosed with gastrointestinal bleeding. Baseline risks of major bleeding in these 21 patients were assessed by using CRUSADE bleeding score system and the clinical features were analyzed retrospectively. Results There have been 21 confirmed cases, including 14（66.7%） aged patients （over 60 year age）, 16（76.2%） male patients, 5（23.8%） patients with smoking history, 5（23.8%） patients with peptic ulcer history, 2（9.5%） patients with gastrointestinal bleeding history, 17（81%） patients with renal insufficiency history, 18（85.7%） patients with heart failure history, 7（33.3%）patients with Helicobacter pylori infection history. Using CRUSADE bleeding score system to assess baseline risk of major bleeding in these 21 patients, 7（33.3%） cases were at very high risk of major bleeding, 5（23.8%） cases at high risk of major bleeding, and 6（28.6%） cases at moderate risk of major bleeding. Among these patients, there were 6 patients with prophylactic use of proton pump inhibitors （PPIs）. PPIs were used in all patients after gastrointestinal bleeding. In this group, more than half （61.9%） were discontinued with all the anti-platelet therapy, and about half （52.4%） were given Clopidogrel only after gastrointestinal bleeding. Conclusion Risk stratification of gastrointestinal bleeding can be made early in patients receiving dual antiplatelet treatment after PCI through using CRUSADE bleeding score system. The use of anti-platelet therapy should be in the light of comprehensive evaluation of the severity of the bleeding and the risk of stent thrombosis once gastrointestinal bleeding occurred.