Mo1181 - Acute Gastrointestinal Bleeding Among Patients on Antiplatelet and Anticoagulant Therapy after Percutaneous Coronary Intervention

Background: Patients undergoing percutaneous coronary intervention (PCI) require dual antiplatelet therapy with low-dose aspirin and Adenosine-Diphosphate receptor antagonist such as clopidogrel.Some patients also require anticoagulation with warfarin or direct oral anticoagulant.Limited data exist on the incidence of acute gastrointestinal bleeding (AGIB) in patients undergoing PCI.In an observational, but not a population-based study, the incidence of AGIB was approximately 2% during the first year after PCI, with 74% of those being from the lower GI tract (Casado Arroyo et al.Heart 2012).We aimed to investigate the incidence of AGIB among patients receiving antiplatelet and anticoagulant therapy and the numbers needed to harm with the different anticoagulants and antiplatelet drugs.Methods: A retrospective population-based study was conducted on all patients undergoing PCI during 2008-2016 in Iceland, prospectively registered in a nationwide PCI database.Data were obtained on antiplatelet and anticoagulant in a pharmaceutical registry on all outpatient prescriptions in Iceland.Computerized diagnoses and endoscopy databases in the University Hospital of Iceland (taking care of 95% of all hospitalization in Iceland) were used to investigate the incidence of AGIB within 12 months after PCI.The inclusion criteria were overt bleeding leading to hospitalization or occurring in a hospitalized patient.Results: A total of 5166 patients underwent PCI during the study period, mean age 65 years (±11), males 75%.The incidence of AGIB was 1.1% (54/5166) per year.Mean age in patients with AGIB was 69 (±9) years but 65 (±11) in non-bleeders (p=0.002).The proportion of acute upper GIB (AUGIB) was 56% (30/54) but acute lower GIB (ALGIB) was 44% (24/54).The most common etiology of AUGIB was gastric ulcer (47%) and 37% of AUGIB were infected with H. pylori.The most common etiology of ALGIB was from diverticulosis (29%).A total of 41% (22/54) of those with AGIB were on PPIs compared to 39% (1992/5112) nonbleeders (NS).The incidence of AGIB among patients on simple antiplatelet therapy combined with an anticoagulant was 2.52% per year compared to 0.91% among those on simple antiplatelet treatment alone (p=0.028).The number needed to harm for one antiplatelet therapy and anticoagulant therapy compared to one antiplatelet therapy was 62. Conclusions: The one-year incidence of AGIB among patients on antiplatelet and anticoagulant therapy after PCI was only approximately 1%, lower than previously reported, potentially due to the population-based nature of the study.Acute GI bleeding was more common from the upper GI tract, which might reflect relatively low PPI use.Bleeding risk seems to be more common among patients on simple antiplatelet therapy along with anticoagulant therapy compared to patients only on simple antiplatelet therapy.