Risk factors for acute gastrointestinal bleeding following myocardial infarction in veteran patients who are prescribed clopidogrel. Issue 4 (April 2014)

• Record Type: Journal Article
• Authors: Cuschieri, Justin R; Drawz, Paul; Falck‐Ytter, Yngve; Wong, Richard C K
• Is Part Of: Journal of digestive diseases. Volume 15:Issue 4(2014:Apr.)
• Page Start: 195
• Page End: 201
• Publication Date: 2014-04
• Subjects: Digestive organs -- Diseases -- Periodicals; Gastroenterology -- Periodicals; 616.3
• DOI: 10.1111/1751-2980.12123
• Languages: English
• ISSNs: 1751-2972

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="cdd12123-sec-0001" sec-type="section"> <title>Objective</title> <p>Our aim was to identify risk factors for acute gastrointestinal (GI) bleeding in patients with myocardial infarction (MI) who were prescribed clopidogrel following hospital discharge.</p> </sec> <sec id="cdd12123-sec-0002" sec-type="section"> <title>Methods</title> <p>Data were collected retrospectively from patients treated in Veteran Affairs hospitals in Ohio, USA, from 2001 to 2008 with a primary diagnosis of MI (International Classification of Diseases, 9th Revision) and a prescription for clopidogrel filled within 48 h of discharge. Primary outcome was acute GI bleeding after discharge.</p> </sec> <sec id="cdd12123-sec-0003" sec-type="section"> <title>Results</title> <p>Acute GI bleeding occurred in 107 of 3218 patients. Bleeding occurred in those who were elder (66.2 <italic>vs</italic> 62.4 years, <italic>P</italic> = 0.0002), had lower glomerular filtration rate (74 <italic>vs</italic> 81 mL/min, <italic>P</italic> = 0.024), had filled prescription for warfarin (15.9% <italic>vs</italic> 6.9%, <italic>P</italic> = 0.0004), diagnosed as atrial fibrillation (20.6% <italic>vs</italic> 11.1%, <italic>P</italic> = 0.003), chronic liver (5.6% <italic>vs</italic> 2.2%, <italic>P</italic> = 0.018) or kidney disease (29.0% vs 19.4%, <italic>P</italic> = 0.016). A risk model and GI bleed risk score were developed and showed that patients with age >65 years, use of warfarin, the presence of chronic liver or kidney disease were at increased risk for GI bleeding.</p> </sec> <sec id="cdd12123-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Veterans patients of advanced age, using warfarin and with chronic liver and kidney disease may be at increased risk of GI bleeding when prescribed clopidogrel following MI. A scoring system may help to identify patients at high risk for GI bleeding.</p> </sec> </abstract>